Healthcare Provider Details

I. General information

NPI: 1366356149
Provider Name (Legal Business Name): BEATA PELI WILTBANK AAS, COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 N GILBERT RD STE 101
GILBERT AZ
85234-3481
US

IV. Provider business mailing address

PO BOX 737441
CHICAGO IL
60673-7441
US

V. Phone/Fax

Practice location:
  • Phone: 480-559-8089
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-050205
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: