Provider Demographics
NPI:1790920247
Name:WAITS, ZEHRA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ZEHRA
Middle Name:
Last Name:WAITS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MAIN CROSS
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-8127
Mailing Address - Country:US
Mailing Address - Phone:502-376-8142
Mailing Address - Fax:
Practice Address - Street 1:501 MAIN CROSS
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-8127
Practice Address - Country:US
Practice Address - Phone:502-376-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist