Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 3146 | AZ |
NPI | 1316122062 |
---|---|
Provider Name | Ms. Carrie Lee Ptacin |
First Address | Tucson, AZ 85750-9022 |
Second Address | Tucson, AZ 85750-9022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2007 |
Last Update Date | 31/12/2007 |