Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2666 | AZ |
NPI | 1003956566 |
---|---|
Provider Name | Carrie Sue Edwards |
First Address | Yuma, AZ 85367-7292 |
Second Address | Yuma, AZ 85364-2973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
803892 | (05) | AZ |