MEDICARE: MIA CATHERINE GRAHAM OT, DOT

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	225X00000X	Occupational Therapist	OTH-008972	AZ

General Provider Information

NPI Number	:	1962126888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA CATHERINE GRAHAM OT, DOT

Provider Business Mailing Address
First Line	:	300 W CLARENDON AVE STE 285
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3474
Country	:	US
Telephone Number	:	602-277-3686
Fax Number	:	602-279-6934

Provider Business Practice Location Address
First Line	:	300 W CLARENDON AVE STE 285
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3474
Country	:	US
Telephone Number	:	602-277-3686
Fax Number	:	602-279-6934

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

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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