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General NPI Number Information
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NPI Number | 1154516805
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Entity Type | Individual
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Provider Name | REBECCA JOANNE FAIRFAX OTR L
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Gender | Female
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 8125 N 23RD AVE SUITE 221
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City | PHOENIX
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State | AZ
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Zip | 85021
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Country | US
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Telephone | 602-443-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 15021 N MAPLE DRIVE
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268
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Country | US
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Telephone | 480-686-8801
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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 | 1331
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License Number State | AZ
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