Provider Demographics
NPI:1851345151
Name:THIES, BRIAN CHRISTOPHER (MS OTRL)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:THIES
Suffix:
Gender:M
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6279
Mailing Address - Country:US
Mailing Address - Phone:480-860-4298
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:3104 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6889
Practice Address - Country:US
Practice Address - Phone:602-224-9891
Practice Address - Fax:602-224-9808
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3066225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00390142OtherRAILROAD MEDICARE PTAN
AZ107805Medicare ID - Type Unspecified