Provider Demographics
NPI:1942652839
Name:CARDELLA, CHRIS (OT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:CARDELLA
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 1:300 W CLARENDON AVE STE 285
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3474
Mailing Address - Country:US
Mailing Address - Phone:602-277-3686
Mailing Address - Fax:602-279-6934
Practice Address - Street 1:790 N ESTRELLA PKWY STE C
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9290
Practice Address - Country:US
Practice Address - Phone:602-765-4348
Practice Address - Fax:623-233-6567
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28792255A2300X
AZOTH-009013225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer