Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4885 | AZ |
N | 225XG0600X | Occupational Therapist - Gerontology | 4885 | AZ |
NPI | 1912390436 |
---|---|
Provider Name | Mary Didde-Esteban |
First Address | Tempe, AZ 85284-2549 |
Second Address | Tempe, AZ 85284-2549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2015 |
Last Update Date | 09/03/2015 |