Provider Demographics
NPI:1962065417
Name:ST PETER, KAMEHA
Entity type:Individual
Prefix:
First Name:KAMEHA
Middle Name:
Last Name:ST PETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 W MAGEE RD APT 13104
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4669
Mailing Address - Country:US
Mailing Address - Phone:520-906-7506
Mailing Address - Fax:
Practice Address - Street 1:3920 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1917
Practice Address - Country:US
Practice Address - Phone:520-471-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
911-87726-04OtherUNITED HEALTHCARE