Provider Demographics
NPI:1649493099
Name:GRACZKOWSKI, MAREK (OTR)
Entity type:Individual
Prefix:
First Name:MAREK
Middle Name:
Last Name:GRACZKOWSKI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 SOMERSET DR
Mailing Address - Street 2:L 218
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-9342
Mailing Address - Country:US
Mailing Address - Phone:954-295-0726
Mailing Address - Fax:
Practice Address - Street 1:23315 BLUE WATER CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7053
Practice Address - Country:US
Practice Address - Phone:561-368-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist