Healthcare Provider Details

I. General information

NPI: 1144822818
Provider Name (Legal Business Name): KENSI NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W ELLIOT RD STE 109
TEMPE AZ
85284-1310
US

IV. Provider business mailing address

1 W ELLIOT RD STE 109
TEMPE AZ
85284-1310
US

V. Phone/Fax

Practice location:
  • Phone: 480-374-4341
  • Fax:
Mailing address:
  • Phone: 480-374-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH010355
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: