Healthcare Provider Details

I. General information

NPI: 1821534710
Provider Name (Legal Business Name): EMILY OKAMURA MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 N 3RD ST SUITE 1000
PHOENIX AZ
85004-1130
US

IV. Provider business mailing address

2702 N 3RD ST SUITE 1000
PHOENIX AZ
85004-1130
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-6410
  • Fax:
Mailing address:
  • Phone: 602-840-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberD07307058
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: