Provider Demographics
NPI:1104510452
Name:ANZALONE, ISAAC C (COTA/L)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:C
Last Name:ANZALONE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 N TORTOLITA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9486
Mailing Address - Country:US
Mailing Address - Phone:520-820-7374
Mailing Address - Fax:
Practice Address - Street 1:1204 E BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1447
Practice Address - Country:US
Practice Address - Phone:520-582-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-046592224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant