Provider Demographics
NPI:1144861113
Name:KOMARZEC, ELYSE RAE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:RAE
Last Name:KOMARZEC
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9151 HOUGHTON ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3445
Mailing Address - Country:US
Mailing Address - Phone:248-212-7938
Mailing Address - Fax:
Practice Address - Street 1:44560 FORD RD STE A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2944
Practice Address - Country:US
Practice Address - Phone:734-680-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010646225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist