Provider Demographics
NPI:1447579990
Name:ZAMORA, JASON (OTD, OTR/L, PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:OTD, OTR/L, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 CHAMBERLAIN DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4156
Mailing Address - Country:US
Mailing Address - Phone:904-377-7732
Mailing Address - Fax:
Practice Address - Street 1:428 CHAMBERLAIN DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4156
Practice Address - Country:US
Practice Address - Phone:904-377-7732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1235169225100000X
TX117809225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist