Healthcare Provider Details

I. General information

NPI: 1659592723
Provider Name (Legal Business Name): DONNA ANN SLAYBAUGH MA, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20402 N 15TH AVE
PHOENIX AZ
85027-3636
US

IV. Provider business mailing address

40125 NORTH NOBLE HAWK COURT
ANTHEM AZ
85086
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-5000
  • Fax:
Mailing address:
  • Phone: 623-551-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2183
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: