Provider Demographics
NPI:1558493338
Name:MEZEY, PATRICIA JEAN (OTRL)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JEAN
Last Name:MEZEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 EAST LUKE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3011
Mailing Address - Country:US
Mailing Address - Phone:602-263-6051
Mailing Address - Fax:602-407-1140
Practice Address - Street 1:4502 N CENTRAL AVE
Practice Address - Street 2:CES LL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1817
Practice Address - Country:US
Practice Address - Phone:602-764-1100
Practice Address - Fax:602-407-1159
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0262225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ771156Medicaid