Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5420 | AZ |
NPI | 1003158668 |
---|---|
Provider Name | Tabitha Macziewski |
First Address | Phoenix, AZ 85028-6024 |
Second Address | Phoenix, AZ 85028-6024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2013 |
Last Update Date | 21/03/2013 |