Healthcare Provider Details

I. General information

NPI: 1437065745
Provider Name (Legal Business Name): OCOTILLO PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 W KINFIELD TRL
PHOENIX AZ
85085-8674
US

IV. Provider business mailing address

1960 W KINFIELD TRL
PHOENIX AZ
85085-8674
US

V. Phone/Fax

Practice location:
  • Phone: 814-657-4441
  • Fax:
Mailing address:
  • Phone: 814-657-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ERIN TAYLOR
Title or Position: MANAGING MEMBER
Credential: CCC-SLP
Phone: 814-657-4441