Provider Demographics
NPI:1003350620
Name:ZACHRY, IRENE A
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:A
Last Name:ZACHRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 YELLOWSTONE DR. PORT ORANGE FL
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127
Mailing Address - Country:US
Mailing Address - Phone:386-872-4892
Mailing Address - Fax:386-256-2159
Practice Address - Street 1:6239 YELLOWSTONE DR. PORT ORANGE FL
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127
Practice Address - Country:US
Practice Address - Phone:386-872-4892
Practice Address - Fax:386-256-2159
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171R00000XOther Service ProvidersInterpreter