Healthcare Provider Details

I. General information

NPI: 1235174632
Provider Name (Legal Business Name): ELISABETH R STUEWE MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12409 W INDIAN SCHOOL RD SUITE C306
AVONDALE AZ
85323-9502
US

IV. Provider business mailing address

22136 W MESQUITE DR
BUCKEYE AZ
85326-5538
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-6040
  • Fax: 623-935-6046
Mailing address:
  • Phone: 623-386-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2723
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: