Provider Demographics
NPI:1588915946
Name:INGRAM, ZACHARY L (OTR)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:L
Last Name:INGRAM
Suffix:
Gender:M
Credentials:OTR
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Mailing Address - Street 1:625 LINCOLN AVE
Mailing Address - Street 2:SUITE 107 PROFESSIONAL PLAZA
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2451
Mailing Address - Country:US
Mailing Address - Phone:724-483-1673
Mailing Address - Fax:724-483-0290
Practice Address - Street 1:3109 UNIVERSITY AVE STE C
Practice Address - Street 2:SELLARO PLAZA
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3205
Practice Address - Country:US
Practice Address - Phone:304-241-4020
Practice Address - Fax:304-241-4029
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
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Provider Licenses
StateLicense IDTaxonomies
WV1588225X00000X
PAOC012445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist