Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OTH007923 | AZ |
NPI | 1063053106 |
---|---|
Provider Name | Amy Carr |
First Address | Phoenix, AZ 85044-5086 |
Second Address | Chandler, AZ 85224-2882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2019 |
Last Update Date | 30/09/2019 |