Provider Demographics
NPI:1457655300
Name:ESSENTIAL THERAPEUTICS, PLLC
Entity Type:Organization
Organization Name:ESSENTIAL THERAPEUTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:480-720-0494
Mailing Address - Street 1:5960 E TINTO ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-0843
Mailing Address - Country:US
Mailing Address - Phone:480-720-0494
Mailing Address - Fax:
Practice Address - Street 1:5960 E TINTO ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-0843
Practice Address - Country:US
Practice Address - Phone:480-720-0494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4348225X00000X, 251C00000X, 251E00000X, 252Y00000X, 261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Single Specialty