Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1333 | AZ |
N | 225XH1200X | Occupational Therapist - Hand | 1333 | AZ |
NPI | 1124156518 |
---|---|
Provider Name | Mrs. Sue Dahl-Popolizio |
First Address | Phoenix, AZ 85027-3943 |
Second Address | Sun City, AZ 85351-3058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 22/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
220501 | (05) | AZ |