Healthcare Provider Details

I. General information

NPI: 1437639812
Provider Name (Legal Business Name): ROBERT WARREN WIRSZ OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 E JACKRABBIT RD
SCOTTSDALE AZ
85250-6730
US

IV. Provider business mailing address

69 W PECAN PL
TEMPE AZ
85284-2257
US

V. Phone/Fax

Practice location:
  • Phone: 480-484-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-007564
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: