Individual
BREANNA CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4350 E RAY RD STE 101A, PHOENIX, AZ 85044-4707
(480) 704-5954
Mailing address
712 W LOUGHLIN DR, CHANDLER, AZ 85225-2124
(480) 390-1552
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTH-007870
AZ
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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