Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 4413 | MA |
NPI | 1013576412 |
---|---|
Provider Name | Ms. Ciara Rae Vazquez |
First Address | Phoenix, AZ 85021-7967 |
Second Address | Phoenix, AZ 85021-7967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2019 |
Last Update Date | 28/06/2019 |