Provider Demographics
NPI:1235309261
Name:TADLOCK, MARK WINN (OT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WINN
Last Name:TADLOCK
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:701 WEST WETMORE RD. RM. 168
Mailing Address - Street 2:PIMA COUNTY AMPHITHEATER SCHOOLS
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5237
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:701 WEST WETMORE RD. RM. 168
Practice Address - Street 2:AMPHITHEATER PUBLIC SCHOOLS
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1547
Practice Address - Country:US
Practice Address - Phone:520-696-5237
Practice Address - Fax:520-696-5067
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1829225X00000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist