Provider Demographics
NPI:1043415714
Name:SOULES, TONYA LEE (OT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LEE
Last Name:SOULES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:LEE
Other - Last Name:KRAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8429 E VIA DE JARDIN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3207
Mailing Address - Country:US
Mailing Address - Phone:480-664-1266
Mailing Address - Fax:
Practice Address - Street 1:8429 E VIA DE JARDIN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3207
Practice Address - Country:US
Practice Address - Phone:480-664-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0569225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics