Individual
LEA YUSUPOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
325 W ANDERSON AVE, PHOENIX, AZ 85023-6545
(602) 570-0105
Mailing address
325 W ANDERSON AVE, PHOENIX, AZ 85023-6545
(602) 570-0105
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTH-009101
AZ
Other
Enumeration date
08/24/2020
Last updated
12/18/2023
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