Healthcare Provider Details

I. General information

NPI: 1558932467
Provider Name (Legal Business Name): ILEANA GUADALUPE SEWELL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W SAINT MARYS RD
TUCSON AZ
85745-2623
US

IV. Provider business mailing address

16850 S SAHUARITA PL
SAHUARITA AZ
85629-9276
US

V. Phone/Fax

Practice location:
  • Phone: 520-872-6267
  • Fax:
Mailing address:
  • Phone: 520-468-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-005137
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: