Healthcare Provider Details

I. General information

NPI: 1316585557
Provider Name (Legal Business Name): MAX PAUL ZWEIG OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 FALLEN LEAF DR
SANTA ROSA CA
95405-7619
US

IV. Provider business mailing address

1915 FALLEN LEAF DR
SANTA ROSA CA
95405-7619
US

V. Phone/Fax

Practice location:
  • Phone: 707-321-6115
  • Fax:
Mailing address:
  • Phone: 707-321-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number12954
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12954
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number12954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: