Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OTH-008255 | AZ |
N | 225XP0200X | Occupational Therapist - Pediatrics | OTH-008255 | AZ |
NPI | 1073129151 |
---|---|
Provider Name | Brittany Ralene Carrie |
First Address | Mesa, AZ 85204-5527 |
Second Address | Scottsdale, AZ 85255-2141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2020 |
Last Update Date | 02/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OTH-00825 | (05) | AZ |