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NPI Code Detail

MEDICARE: MR. SEAN BRUCE IRWIN OTR/L

MEDICARE: MR. SEAN BRUCE IRWIN OTR/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
1225X00000XOccupational TherapistOTH-007705AZ

General Provider Information

NPI Number : 1225594807
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SEAN BRUCE IRWIN OTR/L
Provider Business Mailing Address
First Line : 40143 N WESTRAY WAY
Second Line :
City : SAN TAN VALLEY
State : AZ
Zip : 85140-8416
Country : US
Telephone Number : 480-544-4080
Fax Number :
Provider Business Practice Location Address
First Line : 21630 N 19TH AVE STE B3
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-2717
Country : US
Telephone Number : 602-726-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2019
Last Update Date : 02/19/2019

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