Provider Demographics
NPI:1336455187
Name:ZAGACKI, LAURA M (MS OTR/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:ZAGACKI
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 BOGIE AVE
Mailing Address - Street 2:
Mailing Address - City:WESCOSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9530
Mailing Address - Country:US
Mailing Address - Phone:732-600-4369
Mailing Address - Fax:
Practice Address - Street 1:1456 BOGIE AVE
Practice Address - Street 2:
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9530
Practice Address - Country:US
Practice Address - Phone:732-600-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009641225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist