Provider Demographics
NPI:1386013332
Name:ZAZESKI, AMANDA (OT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ZAZESKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3943
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-654-4642
Practice Address - Street 1:15 ERMER RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-1271
Practice Address - Country:US
Practice Address - Phone:603-893-0984
Practice Address - Fax:603-898-4385
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3039225X00000X
LA300362225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist