Most Relevant Information
Provider Data
| NPI Number: | 1003531435 |
| Provider Name: | ZACHARY TYLER BAKER OTA |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | OT-A1906 |
Most Important Dates
| Enumeration Date: | 10/07/2022 |
| Last Updated: | 02/15/2023 |
Provider Practice Location
610 N MISSOURI ST
WEST MEMPHIS
AR
723013148
Practice Location Phone/Fax
| Phone: | 8704000179 |
| Fax: |
Provider Mailing Location
610 N MISSOURI ST
WEST MEMPHIS
AR
723013148
Provider Mailing Phone/Fax
| Phone: | 8704000179 |
| Fax: |