Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2932 | AZ |
NPI | 1073726121 |
---|---|
Provider Name | Mrs. Sonya Lynn |
First Address | Phoenix, AZ 85086-1464 |
Second Address | Phoenix, AZ 85027-1322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 12/12/2008 |