Healthcare Provider Details

I. General information

NPI: 1619332525
Provider Name (Legal Business Name): PRECILLA INMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 E 5TH ST
TUCSON AZ
85711-1917
US

IV. Provider business mailing address

3920 E 5TH ST
TUCSON AZ
85711-1917
US

V. Phone/Fax

Practice location:
  • Phone: 520-471-0283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-047068
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: