Provider Demographics
NPI:1851048235
Name:EARLY, TATUM LEE (OTR)
Entity Type:Individual
Prefix:
First Name:TATUM
Middle Name:LEE
Last Name:EARLY
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 1:49581 W GAIL LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-3722
Mailing Address - Country:US
Mailing Address - Phone:520-840-7403
Mailing Address - Fax:
Practice Address - Street 1:49581 W GAIL LN
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-3722
Practice Address - Country:US
Practice Address - Phone:520-840-7403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-008743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist