Healthcare Provider Details

I. General information

NPI: 1568370963
Provider Name (Legal Business Name): DESIRAE REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 W AERIE DR
TUCSON AZ
85741-2484
US

IV. Provider business mailing address

38883 S RUNNING ROSES LN
TUCSON AZ
85739-5964
US

V. Phone/Fax

Practice location:
  • Phone: 575-613-3530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-004791
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: