Provider Demographics
NPI:1164410429
Name:PATTERSON, ESSIE F (OTRL CHT)
Entity Type:Individual
Prefix:
First Name:ESSIE
Middle Name:F
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:ESSIE
Other - Middle Name:FAITH
Other - Last Name:MAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:690 N COFCO CENTER CT
Mailing Address - Street 2:STE 260
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6462
Mailing Address - Country:US
Mailing Address - Phone:602-279-6905
Mailing Address - Fax:888-445-4263
Practice Address - Street 1:3033 N WINDSONG DR
Practice Address - Street 2:STE 205
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2290
Practice Address - Country:US
Practice Address - Phone:928-775-4499
Practice Address - Fax:928-115-1546
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0802225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ113265OtherMEDICARE GROUP
AZZ113264OtherMEDICARE GROUP
AZ486622Medicaid
AZZ113265OtherMEDICARE GROUP
S92723Medicare UPIN
AZ1356556963Medicare NSC
AZ1063627677Medicare NSC
AZ60029Medicare ID - Type Unspecified
AZ1831211143Medicare NSC
AZ1972718583Medicare NSC
AZ1629137997Medicare NSC
AZ1568521821Medicare NSC
AZ1396819546Medicare NSC
AZ117354Medicare PIN
AZ486622Medicaid
AZ1124187489Medicare NSC