Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4156 | AZ |
NPI | 1003062118 |
---|---|
Provider Name | Brian Paulsen |
First Address | Fountain Hills, AZ 85268-5440 |
Second Address | Fountain Hills, AZ 85268-4369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2008 |
Last Update Date | 08/10/2015 |