Healthcare Provider Details

I. General information

NPI: 1861745093
Provider Name (Legal Business Name): MARIETTA D TARTAGLIA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8541 E ANDERSON DR STE 100
SCOTTSDALE AZ
85255-5430
US

IV. Provider business mailing address

8541 E ANDERSON DR STE 100
SCOTTSDALE AZ
85255-5430
US

V. Phone/Fax

Practice location:
  • Phone: 480-585-6810
  • Fax: 480-585-6910
Mailing address:
  • Phone: 480-585-6810
  • Fax: 480-585-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5130
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: