Provider Demographics
NPI:1245336882
Name:POMFRET, MARJORIE (OTR, CHT)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:
Last Name:POMFRET
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13840 N NORTHSIGHT BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3665
Mailing Address - Country:US
Mailing Address - Phone:480-860-8380
Mailing Address - Fax:480-451-8318
Practice Address - Street 1:13840 N NORTHSIGHT BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3665
Practice Address - Country:US
Practice Address - Phone:480-860-8380
Practice Address - Fax:480-451-8318
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0246225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78878Medicare PIN