Provider Demographics
NPI:1790144525
Name:NEAL, AUDREY (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S VAL VISTA DR
Mailing Address - Street 2:APT 2012
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6413
Mailing Address - Country:US
Mailing Address - Phone:870-613-6346
Mailing Address - Fax:
Practice Address - Street 1:1320 S VAL VISTA DR
Practice Address - Street 2:APT 2012
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6413
Practice Address - Country:US
Practice Address - Phone:870-613-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6476225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6476OtherARIZONA STATE BOARD OF OCCUPATIONAL THERAPY EXAMINERS