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NPI Code Detail

MEDICARE: MISS ELIZABETH ANN MOCZYDLOWSKI OTRL

MEDICARE: MISS ELIZABETH ANN MOCZYDLOWSKI OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist3379AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1975823OTHERAZAHCCCS ID

General Provider Information

NPI Number : 1467582593
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ELIZABETH ANN MOCZYDLOWSKI OTRL
Provider Business Mailing Address
First Line : 6306 N 7TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-1549
Country : US
Telephone Number : 602-279-5801
Fax Number : 602-279-0785
Provider Business Practice Location Address
First Line : 6306 N 7TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-1549
Country : US
Telephone Number : 602-279-5801
Fax Number : 602-279-0785
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/08/2007

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