Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 4897 | AZ |
NPI | 1821432485 |
---|---|
Provider Name | Mrs. Leanne Morales |
First Address | Holbrook, AZ 86025-3223 |
Second Address | Phoenix, AZ 85021-7967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2013 |
Last Update Date | 24/04/2013 |