MEDICARE: VALERIE PAMELA BAZAN MS, 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
1	225XP0200X	Pediatric Occupational Therapist	2575	AZ

General Provider Information

NPI Number	:	1841402229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE PAMELA BAZAN MS, OTRL

Provider Business Mailing Address
First Line	:	44418 N 12TH ST
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-7314
Country	:	US
Telephone Number	:	602-617-8504
Fax Number	:

Provider Business Practice Location Address
First Line	:	44418 N 12TH ST
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-7314
Country	:	US
Telephone Number	:	602-617-8504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2007
Last Update Date	:	02/18/2014

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