Provider Demographics
NPI:1790412781
Name:ZENTMEYER, MARTHA REAVES
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:REAVES
Last Name:ZENTMEYER
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 1:108 MYRTLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5645
Mailing Address - Country:US
Mailing Address - Phone:813-803-3470
Mailing Address - Fax:
Practice Address - Street 1:108 MYRTLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5645
Practice Address - Country:US
Practice Address - Phone:813-803-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
Provider Identifiers
StateIdentifier IDID TypeIssuer
00006008OtherN/A
FL00085300OtherN/A