Healthcare Provider Details

I. General information

NPI: 1912221250
Provider Name (Legal Business Name): TONYA LYNNE DOTY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14557 W INDIAN SCHOOL RD SUITE 500
GOODYEAR AZ
85395-9243
US

IV. Provider business mailing address

14557 W INDIAN SCHOOL RD STE 500
GOODYEAR AZ
85395-9243
US

V. Phone/Fax

Practice location:
  • Phone: 623-242-6908
  • Fax: 623-242-6909
Mailing address:
  • Phone: 623-242-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4555
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: