Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 1797 | AZ |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1797 | AZ |
N | 225XP0200X | Occupational Therapist - Pediatrics | 1797 | AZ |
NPI | 1770618449 |
---|---|
Provider Name | Simone A. Thomas |
First Address | Glendale, AZ 85301-7453 |
Second Address | Phoenix, AZ 85016-3590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
537912 | (05) | AZ |