Healthcare Provider Details

I. General information

NPI: 1497251250
Provider Name (Legal Business Name): MERKABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3984 N CAMPBELL AVE
TUCSON AZ
85719-1461
US

IV. Provider business mailing address

9221 E BASELINE RD STE A109-617
MESA AZ
85209-8379
US

V. Phone/Fax

Practice location:
  • Phone: 480-251-9171
  • Fax: 480-357-4639
Mailing address:
  • Phone: 480-251-9171
  • Fax: 480-357-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7078
License Number StateAZ

VIII. Authorized Official

Name: MARY LOUISE MULCAHY
Title or Position: ADMIN
Credential:
Phone: 480-251-9171