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General NPI Number Information
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NPI Number | 1194471458
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Entity Type | Individual
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Provider Name | EMILY CHARISSA ZAVALA OT
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Gender | Female
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 20288 MN-15 UNIT 100
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City | HUTCHINSON
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State | MN
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Zip | 55409-1615
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Country | US
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Telephone | 301-471-3588
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Fax |
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Provider Business Mailing Address
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Address Line | 3924 4TH AVE S APT B
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City | MINNEAPOLIS
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State | MN
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Zip | 55409-1615
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Country | US
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Telephone | 301-471-3588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | TL5905
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License Number State | MN
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