Individual
MELLONNA BECKERMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
5777 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Mailing address
5777 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
677
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
842543
—
AZ
Enumeration date
11/20/2005
Last updated
10/26/2007
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