Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 6489 | AZ |
NPI | 1356701841 |
---|---|
Provider Name | Julianne Carlson |
First Address | Chandler, AZ 85224-4837 |
Second Address | Chandler, AZ 85224-4837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2016 |
Last Update Date | 26/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6489 | OCCUPATIONAL THERAPY LICENSE (01) | AZ |