Provider Demographics
NPI:1518734227
Name:PHILLIPS, SANDRA DEE (OTH-003309)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTH-003309
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 E ELYSIAN PASS
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5359
Mailing Address - Country:US
Mailing Address - Phone:480-253-7273
Mailing Address - Fax:
Practice Address - Street 1:2811 E AGRITOPIA LOOP S
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-7834
Practice Address - Country:US
Practice Address - Phone:480-485-8219
Practice Address - Fax:602-296-0456
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-003309225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation