Provider Demographics
NPI:1477541738
Name:WORKMAN, VICTORIA T (OTRL CHT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:T
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:TIONGSON
Other - Last Name:ABELEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3111 CLEARWATER DR
Mailing Address - Street 2:STE C
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7186
Mailing Address - Country:US
Mailing Address - Phone:928-776-4206
Mailing Address - Fax:928-776-4206
Practice Address - Street 1:3111 CLEARWATER DR
Practice Address - Street 2:STE C
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7186
Practice Address - Country:US
Practice Address - Phone:928-776-4206
Practice Address - Fax:928-776-4206
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3428225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ957582Medicaid
AZ120494Medicare PIN
AZ957582Medicaid