Healthcare Provider Details

I. General information

NPI: 1508482100
Provider Name (Legal Business Name): AMANDA ZAGORIA OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 01/17/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 W CYPRESS CREEK RD
FORT LAUDERDALE FL
33309-1858
US

IV. Provider business mailing address

9424 NW 11TH ST
PLANTATION FL
33322-4806
US

V. Phone/Fax

Practice location:
  • Phone: 954-982-7110
  • Fax:
Mailing address:
  • Phone: 954-661-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number20771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: