Provider Demographics
NPI:1669168068
Name:CARON, MICHAELA (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:CARON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 W ROSE GARDEN LN STE 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2725
Mailing Address - Country:US
Mailing Address - Phone:602-808-9912
Mailing Address - Fax:602-875-0385
Practice Address - Street 1:8020 E GELDING DR STE B-101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6948
Practice Address - Country:US
Practice Address - Phone:602-808-9912
Practice Address - Fax:602-875-0385
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-009120225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist