Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 6137 | AZ |
NPI | 1275079675 |
---|---|
Provider Name | Pauline Laubacher |
First Address | Surprise, AZ 85374-5374 |
Second Address | Phoenix, AZ 85021-5469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2017 |
Last Update Date | 10/01/2017 |