Provider Demographics
NPI:1245582634
Name:YSASI, EDELMIRA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:EDELMIRA
Middle Name:
Last Name:YSASI
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 N SUNRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1863
Mailing Address - Country:US
Mailing Address - Phone:419-680-6543
Mailing Address - Fax:480-632-1504
Practice Address - Street 1:3324 E RAY RD UNIT 340
Practice Address - Street 2:
Practice Address - City:HIGLEY
Practice Address - State:AZ
Practice Address - Zip Code:85236-4516
Practice Address - Country:US
Practice Address - Phone:480-265-5557
Practice Address - Fax:480-347-4311
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-009849225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist