Healthcare Provider Details

I. General information

NPI: 1578128872
Provider Name (Legal Business Name): ALEXANDRA DANIELLE ZOTTOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 WOOD ST
MAHOPAC NY
10541-5204
US

IV. Provider business mailing address

340 WOOD ST
MAHOPAC NY
10541-5204
US

V. Phone/Fax

Practice location:
  • Phone: 914-629-2686
  • Fax:
Mailing address:
  • Phone: 914-629-2686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number010098
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: