Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2627 | AZ |
NPI | 1043359300 |
---|---|
Provider Name | Ms. Kelly Dunn Will |
First Address | Tempe, AZ 85282-5336 |
Second Address | Tempe, AZ 85282-5336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |