Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5506 | AZ |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 718 | AK |
NPI | 1124451992 |
---|---|
Provider Name | Denise Marie Mcgowen |
First Address | Peoria, AZ 85382-8048 |
Second Address | Peoria, AZ 85382-8048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2013 |
Last Update Date | 15/08/2013 |