Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1879 | AZ |
NPI | 1023158300 |
---|---|
Provider Name | Ms. Danielle Renea Poulin |
First Address | Tucson, AZ 85701-2252 |
Second Address | Tucson, AZ 85716-3425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |