Provider Demographics
NPI:1588721427
Name:IRWIN, GRETA BAME (OT)
Entity type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:BAME
Last Name:IRWIN
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 1:4540 E LA ESTANCIA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5367
Mailing Address - Country:US
Mailing Address - Phone:520-615-2299
Mailing Address - Fax:520-784-5689
Practice Address - Street 1:2424 N WYATT DR
Practice Address - Street 2:SUITE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6115
Practice Address - Country:US
Practice Address - Phone:520-784-6577
Practice Address - Fax:520-784-6574
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0028225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist