Organization
DYNAMIC FUNCTION THERAPY SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE T VAUGHAN O.T.L. (OWNER)
(605) 490-1554
Entity
Organization
Contact information
Practice address
3140 E FOX ST, MESA, AZ 85213-5418
(605) 490-1554
(480) 634-6442
Mailing address
3140 E FOX ST, MESA, AZ 85213-5418
(605) 490-1554
(480) 634-6442
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4587
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740329887
INDIVIDUAL NPI #
AZ
Enumeration date
07/09/2012
Last updated
07/09/2012
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