Provider Demographics
NPI:1558514703
Name:ZAC-KOSWENER, ZILA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ZILA
Middle Name:
Last Name:ZAC-KOSWENER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 JODI BETH DR
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1060
Mailing Address - Country:US
Mailing Address - Phone:917-930-1161
Mailing Address - Fax:845-628-6942
Practice Address - Street 1:11 JODI BETH DR
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1060
Practice Address - Country:US
Practice Address - Phone:917-930-1161
Practice Address - Fax:845-628-6942
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002587-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist