Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2466 | AZ |
NPI | 1003960857 |
---|---|
Provider Name | Ms. Susan L Fetter |
First Address | Phoenix, AZ 85018-4206 |
Second Address | Tempe, AZ 85283-3652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |