Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5337 | AZ |
N | 225XP0200X | Occupational Therapist - Pediatrics | 5337 | AZ |
NPI | 1023356078 |
---|---|
Provider Name | Samantha Klassen |
First Address | Mesa, AZ 85206-2148 |
Second Address | Mesa, AZ 85206-2148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2013 |
Last Update Date | 26/01/2013 |