Maryanne Rakidzioski, M.O.T

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056.008476 Issued in IL

Practice address

5201 Conner St
Detroit, MI 48213-3405

Phone

(773) 595-6277

NPI assigned

Dec 3, 2007

Last updated

Oct 24, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1073795845",
    "addresses": [
        {
            "country_code": "CA",
            "country_name": "Canada",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "1328 CARRIAGE LANE",
            "city": "WINDSOR",
            "state": "ONTARIO",
            "postal_code": "N9H1Z9",
            "telephone_number": "773-595-6277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 CONNER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482133405",
            "telephone_number": "773-595-6277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAKIDZIOSKI",
        "first_name": "MARYANNE",
        "name_prefix": "Miss",
        "credential": "M.O.T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-03",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201007169",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "12818",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.008476",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "OT9687",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073795845",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madhvi Atul Rajpurkar, MD
• Salman Rajput, MD
• Heather Rajter, RN
• Nadimpalli V Raju, MD
• Ivan Rakic
• Ilya Rakitin, M.D.
• Neeraja Ramachandra, M.D.
• Sampath Ramachandran, M.D.
• Virginia Sue Ramachandran, AU.D.
• Vamsi K Ramachandrapurapu

• Occupational Therapist in Detroit, MI
• Providers in Detroit, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.