Provider Demographics
NPI:1376160507
Name:KROTZER, ANTONIA CHRISTINE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:CHRISTINE
Last Name:KROTZER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 W WINCHCOMB DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5957
Mailing Address - Country:US
Mailing Address - Phone:602-668-5755
Mailing Address - Fax:
Practice Address - Street 1:4870 N LITCHFIELD RD STE B101
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5041
Practice Address - Country:US
Practice Address - Phone:623-935-6040
Practice Address - Fax:480-553-9334
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006750226000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant