Healthcare Provider Details

I. General information

NPI: 1366353831
Provider Name (Legal Business Name): MILANNA KERA WEDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MILANNA KERA MARKOVIC

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S STAPLEY DR STE 119
MESA AZ
85204-6675
US

IV. Provider business mailing address

4097 E NUNNELEY RD
GILBERT AZ
85296-1412
US

V. Phone/Fax

Practice location:
  • Phone: 623-263-3966
  • Fax:
Mailing address:
  • Phone: 480-510-8964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-010385
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: