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General NPI Number Information
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NPI Number | 1881112472
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Entity Type | Organization
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Legal Business Name | PURPOSEFULLY HOME, LLC
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Dates
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Enumeration Date | 09/02/2017
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 1114 N 72ND PL
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-3416
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Country | US
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Telephone | 480-339-9316
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Fax |
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Provider Business Mailing Address
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Address Line | 1114 N 72ND PL
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-3416
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | EMILY REILLY
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Credential | DHSC, OTR/L
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Telephone | 480-339-9316
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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 | 4924
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License Number State | AZ
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