Provider Demographics
NPI:1245996560
Name:EMBODY OCCUPATIONAL THERAPY, LLC
Entity type:Organization
Organization Name:EMBODY OCCUPATIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:520-274-0235
Mailing Address - Street 1:4625 E BROADWAY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3574
Mailing Address - Country:US
Mailing Address - Phone:520-274-0235
Mailing Address - Fax:
Practice Address - Street 1:4625 E BROADWAY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3574
Practice Address - Country:US
Practice Address - Phone:520-274-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty