Provider Demographics
NPI:1457884181
Name:ZAGORIA, MOLLY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:ZAGORIA
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12276 SAN JOSE BLVD STE 508
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8618
Mailing Address - Country:US
Mailing Address - Phone:904-886-3228
Mailing Address - Fax:904-485-8876
Practice Address - Street 1:11701 SAN JOSE BLVD
Practice Address - Street 2:#210
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-0756
Practice Address - Country:US
Practice Address - Phone:904-345-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
FL18288225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist