Provider Demographics
NPI:1861091761
Name:GUZIK, MOLLY (COTA/L, CDP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GUZIK
Suffix:
Gender:F
Credentials:COTA/L, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PEGGYS PATH CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45322-8752
Mailing Address - Country:US
Mailing Address - Phone:937-572-3164
Mailing Address - Fax:
Practice Address - Street 1:600 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1469
Practice Address - Country:US
Practice Address - Phone:937-540-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA2315224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant