Healthcare Provider Details

I. General information

NPI: 1659325439
Provider Name (Legal Business Name): GRETCHEN LYNN BACHMAN OTR L MBS CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN LYNN KAISER OTR L MBS CHT

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 N COFCO CENTER CT SUITE 270
PHOENIX AZ
85008-6462
US

IV. Provider business mailing address

PO BOX 271429
SALT LAKE CITY UT
84127-1429
US

V. Phone/Fax

Practice location:
  • Phone: 602-393-1010
  • Fax: 602-393-1011
Mailing address:
  • Phone: 602-385-2115
  • Fax: 480-422-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2379
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: