Provider Demographics
NPI:1124649603
Name:BOHN, ZACHARY (OTR/L)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:BOHN
Suffix:
Gender:M
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 1:1307 7TH ST N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-3624
Mailing Address - Country:US
Mailing Address - Phone:701-642-6667
Mailing Address - Fax:
Practice Address - Street 1:1307 7TH ST N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-3624
Practice Address - Country:US
Practice Address - Phone:701-642-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105840225X00000X
ND1678225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist