Individual
GRETE K CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3033 N 44TH ST STE 100, PHOENIX, AZ 85018-7227
(602) 631-3161
(602) 631-3162
Mailing address
PO BOX 80217, PHOENIX, AZ 85060-0217
(602) 385-2115
(480) 418-3323
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
5441
AZ
225XH1200X
Hand Occupational Therapist
Primary
5441
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806851
—
AZ
Enumeration date
06/26/2012
Last updated
09/07/2022
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