Healthcare Provider Details

I. General information

NPI: 1386942472
Provider Name (Legal Business Name): VANESSA GRACE ZOLLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7012 TOLEDO RD
SPRING HILL FL
34606-6158
US

IV. Provider business mailing address

7012 TOLEDO RD
SPRING HILL FL
34606-6158
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-1530
  • Fax: 352-597-0502
Mailing address:
  • Phone: 352-597-1530
  • Fax: 352-597-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT13503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: