Provider Demographics
NPI:1922331545
Name:NORMAN, ZACHARY TYLER (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:TYLER
Last Name:NORMAN
Suffix:
Gender:M
Credentials: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:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-0596
Mailing Address - Country:US
Mailing Address - Phone:870-219-0829
Mailing Address - Fax:870-932-1155
Practice Address - Street 1:3898 COUNTY ROAD 318
Practice Address - Street 2:
Practice Address - City:BONO
Practice Address - State:AR
Practice Address - Zip Code:72416-7562
Practice Address - Country:US
Practice Address - Phone:870-219-0829
Practice Address - Fax:870-932-1155
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT0966225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist