Provider Demographics
NPI:1740329887
Name:VAUGHAN, MICHELLE (OT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5358 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4716
Mailing Address - Country:US
Mailing Address - Phone:480-699-9624
Mailing Address - Fax:480-699-8681
Practice Address - Street 1:5358 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4716
Practice Address - Country:US
Practice Address - Phone:480-699-9624
Practice Address - Fax:480-699-8681
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4587225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist