Provider Demographics
NPI:1265670145
Name:STARIKOFF, ELLYN CELIA
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:CELIA
Last Name:STARIKOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 N 32ND ST
Mailing Address - Street 2:BUILDING D
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-5107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1016 N 32ND ST
Practice Address - Street 2:BUILDING D
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-5107
Practice Address - Country:US
Practice Address - Phone:602-914-1332
Practice Address - Fax:602-914-3312
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0038P225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist