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NPI Code Detail

MEDICARE: ZACHARY CORSELL

MEDICARE: ZACHARY CORSELL
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
1224Z00000XOccupational Therapy Assistant15530FL

General Provider Information

NPI Number : 1811520356
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACHARY CORSELL
Provider Business Mailing Address
First Line : 10937 INGLEWOOD AVE
Second Line :
City : PORT RICHEY
State : FL
Zip : 34668-2512
Country : US
Telephone Number : 727-389-2777
Fax Number :
Provider Business Practice Location Address
First Line : 1114 CHATMAN BLVD
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34601-3104
Country : US
Telephone Number : 352-796-6701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2020
Last Update Date : 02/12/2020

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Directions to “ ZACHARY CORSELL ” Practice Location

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