MEDICARE: MR. TATE FRYCZYNSKI MOT, OTR

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	OTH-010168	AZ

General Provider Information

NPI Number	:	1467325951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TATE FRYCZYNSKI MOT, OTR

Provider Business Mailing Address
First Line	:	42424 N GAVILAN PEAK PKWY UNIT 16206
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3710
Country	:	US
Telephone Number	:	201-994-9940
Fax Number	:

Provider Business Practice Location Address
First Line	:	20414 N 27TH AVE STE 410
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3250
Country	:	US
Telephone Number	:	623-263-3966
Fax Number	:

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

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	03/09/2026

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