Healthcare Provider Details

I. General information

NPI: 1295688109
Provider Name (Legal Business Name): MERCEDES RAE HALLSTED OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERCEDES RAE THOMPSON

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 E MELROSE ST
GILBERT AZ
85297-1001
US

IV. Provider business mailing address

PO BOX 80217
PHOENIX AZ
85060-0217
US

V. Phone/Fax

Practice location:
  • Phone: 602-648-5444
  • Fax: 602-772-3801
Mailing address:
  • Phone: 602-385-2115
  • Fax: 480-418-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTH-010322
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: