Provider Demographics
NPI:1841953296
Name:JAROSIEWICZ, TRISTAN (OTR/L)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:JAROSIEWICZ
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38629 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-8802
Mailing Address - Country:US
Mailing Address - Phone:734-659-7344
Mailing Address - Fax:
Practice Address - Street 1:2102 ORLEANS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2769
Practice Address - Country:US
Practice Address - Phone:313-462-4362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201012658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist