Provider Demographics
NPI:1538842893
Name:KLOCK, AIMEE RAE ANN
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:RAE ANN
Last Name:KLOCK
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 1:330 W MEDLOCK DR APT 108
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2368
Mailing Address - Country:US
Mailing Address - Phone:602-446-5015
Mailing Address - Fax:
Practice Address - Street 1:5025 E WASHINGTON ST STE 212
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-7439
Practice Address - Country:US
Practice Address - Phone:602-773-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-00928225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist