Provider Demographics
NPI:1174881809
Name:ZIOLKOWSKI, CARLA AMANDA (OTR)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:AMANDA
Last Name:ZIOLKOWSKI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-9503
Mailing Address - Country:US
Mailing Address - Phone:715-361-5480
Mailing Address - Fax:
Practice Address - Street 1:1630 CHIPPEWA DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-9503
Practice Address - Country:US
Practice Address - Phone:715-361-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5152-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist