Individual
RUMEN ANTONIEV PETKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
5168 W AUGUSTA AVE, GLENDALE, AZ 85301-1469
(651) 442-5094
Mailing address
5168 W AUGUSTA AVE, GLENDALE, AZ 85301-1469
(651) 442-5094
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTH-007999
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
432233
NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY (NBCOT)
—
Enumeration date
07/06/2015
Last updated
08/23/2021
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