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General NPI Number Information
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NPI Number | 1174932768
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Entity Type | Individual
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Provider Name | TATE SHIMON MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 9376 E BAHIA DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1532
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Country | US
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Telephone | 602-819-4294
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Fax |
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Provider Business Mailing Address
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Address Line | 8410 N CENTRAL AVE UNIT B
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City | PHOENIX
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State | AZ
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Zip | 85020-3563
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Country | US
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Telephone | 602-819-4294
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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 | 5805
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License Number State | AZ
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