1912179367 NPI number — MS. CAROL LEE PHELAN-SMITH OTR/L CHT

Table of content: MS. CAROL LEE PHELAN-SMITH OTR/L CHT (NPI 1912179367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912179367 NPI number — MS. CAROL LEE PHELAN-SMITH OTR/L CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHELAN-SMITH
Provider First Name:
CAROL
Provider Middle Name:
LEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912179367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 90162
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85752-0162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-579-0078
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1921 W HOSPITAL DR
Provider Second Line Business Practice Location Address:
HEALTHSOUTH REHAB HOSPITAL
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85704-7806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-544-5442
Provider Business Practice Location Address Fax Number:
520-544-5430
Provider Enumeration Date:
03/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  0610 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0610 . This is a "OCCUPATIONAL THERAPIST" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 9105000884 . This is a "CERTIFIED HAND THERAPIST" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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