Healthcare Provider Details

I. General information

NPI: 1841402229
Provider Name (Legal Business Name): VALERIE PAMELA BAZAN MS, OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44418 N 12TH ST
NEW RIVER AZ
85087-7314
US

IV. Provider business mailing address

44418 N 12TH ST
NEW RIVER AZ
85087-7314
US

V. Phone/Fax

Practice location:
  • Phone: 602-617-8504
  • Fax:
Mailing address:
  • Phone: 602-617-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2575
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: