Provider Demographics
NPI:1073283354
Name:BRANCH, ZAHKEYA RENEA (COTA/L)
Entity type:Individual
Prefix:
First Name:ZAHKEYA
Middle Name:RENEA
Last Name:BRANCH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18121 STERLING GATE CIR BLDG 10
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1789
Mailing Address - Country:US
Mailing Address - Phone:813-357-9973
Mailing Address - Fax:
Practice Address - Street 1:4025 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3208
Practice Address - Country:US
Practice Address - Phone:727-712-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18489224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty