Healthcare Provider Details

I. General information

NPI: 1558539197
Provider Name (Legal Business Name): CHANDA ZAVODNY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-957 MAMALAHOA HWY
KAMUELA HI
96743-8415
US

IV. Provider business mailing address

PO BOX 1020
CAPTAIN COOK HI
96704-1020
US

V. Phone/Fax

Practice location:
  • Phone: 321-537-0067
  • Fax:
Mailing address:
  • Phone: 321-537-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT10297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: