Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 0802 | AZ |
NPI | 1164410429 |
---|---|
Provider Name | Essie F Patterson |
First Address | Phoenix, AZ 85008-6462 |
Second Address | Prescott Valley, AZ 86314-2290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 08/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
486622 | (05) | AZ |
S92723 | (02) | |
Z113264 | MEDICARE GROUP (01) | AZ |
Z113265 | MEDICARE GROUP (01) | AZ |