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General NPI Number Information
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NPI Number | 1104100080
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Entity Type | Individual
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Provider Name | MICHELLE LORRAINE SLADEK
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Gender | Female
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1221 W WARNER RD SUITE 102
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City | TEMPE
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State | AZ
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Zip | 85284-1906
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Country | US
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Telephone | 480-735-0124
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Fax | 480-735-0126
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Provider Business Mailing Address
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Address Line | 646 N ELM ST
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City | CHANDLER
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State | AZ
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Zip | 85226-2738
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Country | US
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Telephone | 480-577-8332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0764
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License Number State | AZ
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