MEDICARE: TAMARA ZALAZAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1114150521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA ZALAZAR

Provider Business Mailing Address
First Line	:	2501 ORANGE TREE LOOP
Second Line	:	APT 201
City	:	TAMPA
State	:	FL
Zip	:	33618-3345
Country	:	US
Telephone Number	:	813-317-7112
Fax Number	:	813-374-4891

Provider Business Practice Location Address
First Line	:	2501 ORANGE TREE LOOP
Second Line	:	APT 201
City	:	TAMPA
State	:	FL
Zip	:	33618-3345
Country	:	US
Telephone Number	:	813-317-7112
Fax Number	:	813-374-4891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	04/19/2013

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