Individual
MS. MARY KATHRYN VANDERWORP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
6115 N 12TH ST, UNIT #3, PHOENIX, AZ 85014-1717
(602) 993-4191
Mailing address
6115 N 12TH ST, UNIT #3, PHOENIX, AZ 85014-1717
(602) 993-4191
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0409
AZ
Other
Enumeration date
10/12/2009
Last updated
11/18/2009
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