MEDICARE: ST. MICHAELS ASSOCIATION FOR SPECIAL EDUCATION

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	225X00000X	Occupational Therapist	3282	AZ

General Provider Information

NPI Number	:	1235353806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MICHAELS ASSOCIATION FOR SPECIAL EDUCATION

Provider Business Mailing Address
First Line	:	PO BOX 100
Second Line	:
City	:	ST MICHAELS
State	:	AZ
Zip	:	86511-0100
Country	:	US
Telephone Number	:	928-871-2822
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MILE NORTH OF RT. 264 ON MUSTANG ROAD
Second Line	:
City	:	ST. MICHAELS
State	:	AZ
Zip	:	86511-0100
Country	:	US
Telephone Number	:	928-871-2822
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. GILLIS CHAPELA
Credential	:
Telephone Number	:	928-871-2800

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	04/23/2008

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