Provider Demographics
NPI:1548985542
Name:DUSZA, JASON (OTRL)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DUSZA
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6783 TALBOT DR
Mailing Address - Street 2:
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-7903
Mailing Address - Country:US
Mailing Address - Phone:586-651-8667
Mailing Address - Fax:
Practice Address - Street 1:5402 GATEWAY CTR STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3918
Practice Address - Country:US
Practice Address - Phone:586-651-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008339225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist