Provider Demographics
NPI:1164843710
Name:SZELWACH, MALGORZATA ANNA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:ANNA
Last Name:SZELWACH
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 E CUTLAR CROSSING
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-6484
Mailing Address - Country:US
Mailing Address - Phone:910-332-3800
Mailing Address - Fax:
Practice Address - Street 1:1168 E CUTLAR XING
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-6484
Practice Address - Country:US
Practice Address - Phone:910-332-3800
Practice Address - Fax:910-251-0421
Is Sole Proprietor?:No
Enumeration Date:2013-12-29
Last Update Date:2021-03-10
Deactivation Date:2019-11-25
Deactivation Code:
Reactivation Date:2019-12-05
Provider Licenses
StateLicense IDTaxonomies
FL20453225X00000X
247200000X
NC13806225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other