Healthcare Provider Details

I. General information

NPI: 1386013332
Provider Name (Legal Business Name): AMANDA ZAZESKI OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ERMER RD
SALEM NH
03079-1271
US

IV. Provider business mailing address

4845 MAIN ST STE B
ZACHARY LA
70791-3943
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-0984
  • Fax: 603-898-4385
Mailing address:
  • Phone: 225-654-8208
  • Fax: 225-654-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3039
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number300362
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: