MEDICARE: PREMIER PEDIATRICS LLC

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	2363	AZ

General Provider Information

NPI Number	:	1861664724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	7803 E. MARQUISE DRIVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3773
Country	:	US
Telephone Number	:	520-977-8924
Fax Number	:	520-721-4948

Provider Business Practice Location Address
First Line	:	7803 E MARQUISE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3773
Country	:	US
Telephone Number	:	520-977-8924
Fax Number	:	520-742-2082

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MS. VIVIENNE CAROL MEANGER
Credential	:	MHS, OTR/L
Telephone Number	:	520-977-8924

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	06/04/2009

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