MEDICARE: JENNIFER ZAK OTR/L

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	225X00000X	Occupational Therapist	OC009532	PA

General Provider Information

NPI Number	:	1154510295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ZAK OTR/L

Provider Business Mailing Address
First Line	:	301 BYBERRY RD
Second Line	:	APT. E 25
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 BYBERRY RD
Second Line	:	APT. E 25
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1947
Country	:	US
Telephone Number	:	267-237-3489
Fax Number	:

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

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	10/15/2007

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