Healthcare Provider Details

I. General information

NPI: 1174200794
Provider Name (Legal Business Name): PAIGE MAREE MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N/A N/A N/A

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N 5TH ST
PHOENIX AZ
85004-2157
US

IV. Provider business mailing address

106 HOHOKAM
MORENCI AZ
85540-9610
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-4016
  • Fax:
Mailing address:
  • Phone: 928-792-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-010478
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: