MEDICARE: ISAAC C ANZALONE COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA-046592	AZ

General Provider Information

NPI Number	:	1104510452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC C ANZALONE COTA/L

Provider Business Mailing Address
First Line	:	5102 N TORTOLITA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-9486
Country	:	US
Telephone Number	:	520-820-7374
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 E BASELINE RD STE 106
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1447
Country	:	US
Telephone Number	:	520-582-0142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	07/28/2023

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