Provider Demographics
NPI:1073368650
Name:BASELT, ZAKERIYA LATRICE (OTR/L)
Entity type:Individual
Prefix:
First Name:ZAKERIYA
Middle Name:LATRICE
Last Name:BASELT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 SAVOY CT APT 101
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3174
Mailing Address - Country:US
Mailing Address - Phone:602-829-6026
Mailing Address - Fax:
Practice Address - Street 1:2040 WOODSON RD STE 201
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5606
Practice Address - Country:US
Practice Address - Phone:314-627-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024012966225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist