Provider Demographics
NPI:1124156518
Name:DAHL-POPOLIZIO, SUE (OT)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:
Last Name:DAHL-POPOLIZIO
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 1:3010 W AGUA FRIA FWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3943
Mailing Address - Country:US
Mailing Address - Phone:623-537-5600
Mailing Address - Fax:623-537-5601
Practice Address - Street 1:10494 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3058
Practice Address - Country:US
Practice Address - Phone:623-537-5600
Practice Address - Fax:623-537-5601
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1333225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ220501Medicaid