Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2236 | AZ |
NPI | 1043397649 |
---|---|
Provider Name | Alice M Young |
First Address | Tempe, AZ 85282-5723 |
Second Address | Phoenix, AZ 85051-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 16/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
445818 | (05) | AZ |