Basic Information
| Provider Information | |||||||||
| NPI: | 1063545218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAVALETA | ||||||||
| FirstName: | RICARDO | ||||||||
| MiddleName: | RAFAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OTRL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 YACHTSMAN'S POINT DRIVE | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046365812 | ||||||||
| FaxNumber: | 7046368373 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 JULIAN RD | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281479079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046365812 | ||||||||
| FaxNumber: | 7046368373 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 3169 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.