Organization
ETIPSER L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA LYNN SHAMAH (ADMINISTRATOR)
(480) 612-4985
Entity
Organization
Contact information
Practice address
405 W SOUTHERN AVE, SUITE #3, TEMPE, AZ 85282-4500
(480) 612-4985
(480) 636-8504
Mailing address
405 W SOUTHERN AVE, SUITE #3, TEMPE, AZ 85282-4500
(480) 612-4985
(480) 636-8504
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
11/27/2009
Last updated
11/27/2009
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