Provider Demographics
NPI:1174020739
Name:ZIETZ, CODY ROBERT (OTR/L)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:ROBERT
Last Name:ZIETZ
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 1:2788 S THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-9703
Mailing Address - Country:US
Mailing Address - Phone:989-928-5536
Mailing Address - Fax:
Practice Address - Street 1:6170 US HIGHWAY 31 N
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-8306
Practice Address - Country:US
Practice Address - Phone:231-421-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010104225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist