Basic Information
| Provider Information | |||||||||
| NPI: | 1801399159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PINDAR | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | BROOK BOUDER | ||||||||
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| Credential: | OTR/L | ||||||||
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| OtherLastName: | PINDAR | ||||||||
| OtherFirstName: | ZACHARY | ||||||||
| OtherMiddleName: | B | ||||||||
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| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4865 CYPRESS WOODS DR APT 2107 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328113763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458260705 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1297 WINTER GARDEN VINELAND RD # 112 | ||||||||
| Address2: | |||||||||
| City: | WINTER GARDEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347876706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078523300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2018 | ||||||||
| LastUpdateDate: | 03/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 19080 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.