Provider Demographics
NPI:1215315262
Name:ROBERSON, ZAKIYYAH D (OT)
Entity type:Individual
Prefix:
First Name:ZAKIYYAH
Middle Name:D
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ZAKIYYAH
Other - Middle Name:
Other - Last Name:MICKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:4581 EDEN WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-2895
Mailing Address - Country:US
Mailing Address - Phone:716-316-9085
Mailing Address - Fax:
Practice Address - Street 1:139 NORTHLAND AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-1102
Practice Address - Country:US
Practice Address - Phone:716-316-9085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0829796224Z00000X
FLOT21641225X00000X
NY025815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0829796OtherLICENSE