Healthcare Provider Details

I. General information

NPI: 1730096405
Provider Name (Legal Business Name): MEMRIE SLOAN LANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 N 67TH AVE
GLENDALE AZ
85301-8214
US

IV. Provider business mailing address

123 COUNTY R0AD 1439
MOOREVILLE MS
38857-7809
US

V. Phone/Fax

Practice location:
  • Phone: 623-237-4006
  • Fax:
Mailing address:
  • Phone: 662-646-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-010421
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: