Provider Demographics
NPI:1659895969
Name:O'LEARY, GRACE (MT-BC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:CHAISSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2212 S 83RD LN
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-8915
Mailing Address - Country:US
Mailing Address - Phone:623-337-6543
Mailing Address - Fax:
Practice Address - Street 1:200 E CURRY RD RM 307C
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2009
Practice Address - Country:US
Practice Address - Phone:480-965-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist