Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA-046628 | AZ |
NPI | 1013490820 |
---|---|
Provider Name | Pilar Elise Spishock |
First Address | Chandler, AZ 85226-1624 |
Second Address | Mesa, AZ 85206-2798 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2018 |
Last Update Date | 08/09/2018 |