Individual
ELIZABETH WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1235 E HARMONT DR, PHOENIX, AZ 85020-3864
(602) 331-1470
Mailing address
8026 W CORRINE DR, PEORIA, AZ 85381-9034
(509) 995-5232
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
7177
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-4292737
IRS
AZ
Enumeration date
02/07/2018
Last updated
03/17/2018
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