Provider Demographics
NPI:1326562471
Name:MCCULLEY, AUBREY ROXANNE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:ROXANNE
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8530 N 22ND AVE APT 2121
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-6035
Mailing Address - Country:US
Mailing Address - Phone:520-891-6085
Mailing Address - Fax:
Practice Address - Street 1:7355 W ORANGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-1645
Practice Address - Country:US
Practice Address - Phone:623-237-4016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7088225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7088OtherARIZONA BOARD OF OCCUPATIONAL THERAPY EXAMINERS