Organization
OPTIMAL KIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY SHOUSE MS, OTR/L (OCCUPATIONAL THERAPIST)
(623) 628-7806
Entity
Organization
Contact information
Practice address
2506 S 115TH LN, AVONDALE, AZ 85323-7637
(623) 628-7806
Mailing address
2506 S 115TH LN, AVONDALE, AZ 85323-7637
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
10/02/2019
Last updated
10/02/2019
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