Healthcare Provider Details

I. General information

NPI: 1659955441
Provider Name (Legal Business Name): EMILY FASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 05/08/2021
Certification Date: 05/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 E RAY RD BLDG 1 SUITE 101A
PHOENIX AZ
85044-4703
US

IV. Provider business mailing address

15333 N HAYDEN RD UNIT 3314
SCOTTSDALE AZ
85260-3088
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-5954
  • Fax: 480-704-5807
Mailing address:
  • Phone: 920-284-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH008430
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTH008430
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: