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NPI Code Detail

MEDICARE: MRS. VIRGINIA MARY KACZOR OTR

MEDICARE: MRS. VIRGINIA MARY KACZOR OTR
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 Therapist0308AZ

General Provider Information

NPI Number : 1548319841
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VIRGINIA MARY KACZOR OTR
Provider Business Mailing Address
First Line : 16428 E KINGSTREE BLVD
Second Line :
City : FOUNTAIN HILLS
State : AZ
Zip : 85268-5440
Country : US
Telephone Number : 480-837-4565
Fax Number : 480-836-1992
Provider Business Practice Location Address
First Line : 16428 E KINGSTREE BLVD
Second Line :
City : FOUNTAIN HILLS
State : AZ
Zip : 85268-5440
Country : US
Telephone Number : 480-837-4565
Fax Number : 480-836-1992
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 07/08/2007

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