Provider Demographics
NPI:1245582634
Name:YSASI, EDELMIRA (COTA)
Entity Type:Individual
Prefix:
First Name:EDELMIRA
Middle Name:
Last Name:YSASI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N LINDSAY RD STE 111
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5808
Mailing Address - Country:US
Mailing Address - Phone:480-632-2757
Mailing Address - Fax:480-632-1504
Practice Address - Street 1:33 N LINDSAY RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5808
Practice Address - Country:US
Practice Address - Phone:480-632-2757
Practice Address - Fax:480-632-1504
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5239224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant