Healthcare Provider Details

I. General information

NPI: 1609278001
Provider Name (Legal Business Name): ANGELA ESCALANTE MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA MARIE THIELEN MS OTR/L

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E CLAREMONT ST
PHOENIX AZ
85014-1962
US

IV. Provider business mailing address

715 E CLAREMONT ST
PHOENIX AZ
85014-1962
US

V. Phone/Fax

Practice location:
  • Phone: 602-448-3904
  • Fax:
Mailing address:
  • Phone: 602-448-3904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4649
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: