Healthcare Provider Details

I. General information

NPI: 1417677568
Provider Name (Legal Business Name): CHELSEA ELIZABETH FAGAN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5452
US

IV. Provider business mailing address

13310 N PLAZA DEL RIO BLVD UNIT 2011
PEORIA AZ
85381-0013
US

V. Phone/Fax

Practice location:
  • Phone: 480-301-8000
  • Fax:
Mailing address:
  • Phone: 484-885-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-008965
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: