Provider Demographics
NPI:1255470902
Name:FANCHER, CARRIE (OT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:FANCHER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6032 E VOLTAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3849
Mailing Address - Country:US
Mailing Address - Phone:602-750-8125
Mailing Address - Fax:
Practice Address - Street 1:300 W CLARENDON AVE STE 285
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3474
Practice Address - Country:US
Practice Address - Phone:602-279-6905
Practice Address - Fax:602-279-6934
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3435225XE1200X, 225XH1200X, 225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics