Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 571 | AZ |
NPI | 1003946005 |
---|---|
Provider Name | Mary Ann Sheely |
First Address | Phoenix, AZ 85016-7146 |
Second Address | Mesa, AZ 85210-4938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
770075 | (05) | AZ |