MEDICARE: VALERIE A MAYRSOHN O T

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	2101	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2101	OTHER	AZ	STATE LICENSE

General Provider Information

NPI Number	:	1568524239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE A MAYRSOHN O T

Provider Business Mailing Address
First Line	:	3257 N GLEN CREEK DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1138
Country	:	US
Telephone Number	:	520-360-9591
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-2717
Country	:	US
Telephone Number	:	520-326-2782
Fax Number	:	520-296-3552

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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Directions to “ VALERIE A MAYRSOHN O T” Practice Location

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