Provider Demographics
NPI:1114126315
Name:KIERNAN, TRICIA A (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:A
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 E BAUTISTA RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5202
Mailing Address - Country:US
Mailing Address - Phone:480-322-8863
Mailing Address - Fax:
Practice Address - Street 1:3927 E BAUTISTA RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-5202
Practice Address - Country:US
Practice Address - Phone:480-322-8863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist