Provider Demographics
NPI:1760610828
Name:WOLFE, PHILLIP STANLEY (OT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:STANLEY
Last Name:WOLFE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16020 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4206
Mailing Address - Country:US
Mailing Address - Phone:480-290-3568
Mailing Address - Fax:
Practice Address - Street 1:16020 S 23RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-4206
Practice Address - Country:US
Practice Address - Phone:480-290-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0443225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics