Healthcare Provider Details

I. General information

NPI: 1669945267
Provider Name (Legal Business Name): ANNE ZIMMERMAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20329 N 59TH AVE STE A2
GLENDALE AZ
85308-6854
US

IV. Provider business mailing address

5337 W PIUTE AVE
GLENDALE AZ
85308-5071
US

V. Phone/Fax

Practice location:
  • Phone: 623-594-0294
  • Fax:
Mailing address:
  • Phone: 602-561-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTH-002783
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: