Provider Demographics
NPI:1790796670
Name:ZALATAN, WENDY A (OTRL)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:ZALATAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-852-0600
Mailing Address - Fax:508-853-1907
Practice Address - Street 1:135 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:508-852-0600
Practice Address - Fax:508-853-1907
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherONE HEALTH PLAN
43222OtherFALLON COMMUNITY HEALTH P
670001296OtherRAILROAD MEDICARE
787401OtherMVP HEALTH CARE
042472266OtherHEALTHCARE VALUE MANAGEME
Y68484OtherMEDICARE B
042472266OtherTHREE RIVERS
2779432OtherCIGNA HEALTH PLAN
7693616OtherAETNA US HEALTHCARE
394700OtherMEDICAID WELFARE
MA394700Medicaid
OT0067OtherBLUE CROSS
042472266OtherPRIVATE HEALTHCARE SYSTEM
AA4053OtherHARVARD PILGRIM HEALTHCAR
042472266OtherTHREE RIVERS