Individual
NHU MAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
1445 E HILTON AVE, MESA, AZ 85204-5938
(714) 808-2072
Mailing address
1419 S ALLEN, MESA, AZ 85204-5950
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
OTA-007328
AZ
225X00000X
Occupational Therapist
Primary
OTH-009528
AZ
Other
Enumeration date
08/16/2019
Last updated
05/22/2025
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