Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5140 | AZ |
NPI | 1255311312 |
---|---|
Provider Name | Denise Ann Fetzner |
First Address | Goodyear, AZ 85395-7707 |
Second Address | Goodyear, AZ 85395-7707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 11/01/2013 |