=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184753428
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRICIA DIANE FINGER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12409 W INDIAN SCHOOL RD SUITE C-306
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85323-9502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-935-6040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2033 W PALO VERDE DR
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85015-2447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-246-9750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 3310
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------