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General NPI Number Information
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NPI Number | 1366353831
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Entity Type | Individual
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Provider Name | MILANNA KERA WEDGE
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Gender | Female
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 1910 S STAPLEY DR STE 119
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City | MESA
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State | AZ
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Zip | 85204-6675
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Country | US
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Telephone | 623-263-3966
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Fax |
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Provider Business Mailing Address
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Address Line | 4097 E NUNNELEY RD
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City | GILBERT
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State | AZ
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Zip | 85296-1412
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Country | US
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Telephone | 480-510-8964
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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 | OTH-010385
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License Number State | AZ
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