Provider Demographics
NPI:1275326399
Name:ZIMMERMAN, CYNTHIA L (C/OTA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:C/OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 SEDGEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5092
Mailing Address - Country:US
Mailing Address - Phone:330-631-4497
Mailing Address - Fax:
Practice Address - Street 1:9405 SEDGEFIELD AVE
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5092
Practice Address - Country:US
Practice Address - Phone:330-631-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist