Healthcare Provider Details

I. General information

NPI: 1669067773
Provider Name (Legal Business Name): MONICA JEAN ZAVACKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S CALUMET RD STE 3
CHESTERTON IN
46304-3286
US

IV. Provider business mailing address

1120 S CALUMET RD STE 3
CHESTERTON IN
46304-3286
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-9675
  • Fax:
Mailing address:
  • Phone: 219-983-9675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31007336A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: