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Individual

MRS. REGINA SHAWN KENYON CARLSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
15452 CHOLLA CIR, MAYER, AZ 86333
(928) 443-7673
Mailing address
12609 W CERCADO LN, LITCHFIELD PARK, AZ 85340-5509
(602) 391-6911

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3200
AZ

Other

Enumeration date
04/24/2007
Last updated
02/01/2019
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