Provider Demographics
NPI:1891837191
Name:BRAZZELL, FRAN (OT)
Entity Type:Individual
Prefix:MS
First Name:FRAN
Middle Name:
Last Name:BRAZZELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4551 E CAMINO PIMERIA ALTA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3548
Mailing Address - Country:US
Mailing Address - Phone:520-243-0212
Mailing Address - Fax:
Practice Address - Street 1:4551 E CAMINO PIMERIA ALTA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-3548
Practice Address - Country:US
Practice Address - Phone:520-243-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103105Medicaid