Provider Demographics
NPI:1356679575
Name:ZAGACKI, MAUREEN A (COTA)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:A
Last Name:ZAGACKI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3694 STANTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1619
Mailing Address - Country:US
Mailing Address - Phone:215-438-5894
Mailing Address - Fax:
Practice Address - Street 1:1020 OAK LANE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-3340
Practice Address - Country:US
Practice Address - Phone:215-570-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-29
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002665L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant