Provider Demographics
NPI:1922300920
Name:O'CONNOR, MARTHA SUSAN (OT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:SUSAN
Last Name:O'CONNOR
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 1:9357 N 87TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1932
Mailing Address - Country:US
Mailing Address - Phone:480-634-8912
Mailing Address - Fax:480-393-7750
Practice Address - Street 1:6601 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-1219
Practice Address - Country:US
Practice Address - Phone:602-336-0061
Practice Address - Fax:602-336-0249
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4197225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist