Provider Demographics
NPI:1760522395
Name:SONG, LINDA CLAUDINE (OTR)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:CLAUDINE
Last Name:SONG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10284 E MALLOW CIR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8506
Mailing Address - Country:US
Mailing Address - Phone:602-881-7819
Mailing Address - Fax:
Practice Address - Street 1:10284 E MALLOW CIRCLE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-2663
Practice Address - Country:US
Practice Address - Phone:602-881-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2426225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist