Provider Demographics
NPI:1285167791
Name:ZALAR, KENNETH ANTHONY (COTA/L)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ANTHONY
Last Name:ZALAR
Suffix:
Gender:M
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 1:10301 LAKE AVE APT 317
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1275
Mailing Address - Country:US
Mailing Address - Phone:440-537-0242
Mailing Address - Fax:
Practice Address - Street 1:5028 FOREST RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1308
Practice Address - Country:US
Practice Address - Phone:440-257-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06060224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant