Provider Demographics
NPI:1720613227
Name:DE VET, PAULINE (BC-MT, NMT)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:DE VET
Suffix:
Gender:F
Credentials:BC-MT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557 N DREAMY DRAW DR UNIT 225
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4656
Mailing Address - Country:US
Mailing Address - Phone:480-401-7333
Mailing Address - Fax:
Practice Address - Street 1:2702 N 3RD ST STE 1000
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4605
Practice Address - Country:US
Practice Address - Phone:602-840-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15707225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist