Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1515 | AZ |
NPI | 1003007949 |
---|---|
Provider Name | Bonnie L. Mroczkowski |
First Address | Tucson, AZ 85710-7951 |
Second Address | Tucson, AZ 85712-2716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 06/08/2007 |