Provider Demographics
NPI:1316565310
Name:ZARKOS, JENNIFER IRENE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:IRENE
Last Name:ZARKOS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3515
Mailing Address - Country:US
Mailing Address - Phone:760-331-9145
Mailing Address - Fax:
Practice Address - Street 1:12225 GREENVILLE AVE STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-9362
Practice Address - Country:US
Practice Address - Phone:513-453-7805
Practice Address - Fax:214-272-2714
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14734225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist