Provider Demographics
NPI:1750864591
Name:TENCHAVEZ, MICHAEL ZAFRA (OTR)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ZAFRA
Last Name:TENCHAVEZ
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 SISTINE CHAPEL CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7960
Mailing Address - Country:US
Mailing Address - Phone:870-275-5239
Mailing Address - Fax:
Practice Address - Street 1:3010 MIDDLEFIELD DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7428
Practice Address - Country:US
Practice Address - Phone:870-802-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1680225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist