Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 353569 | AZ |
NPI | 1699308270 |
---|---|
Provider Name | Jodi Eileen Edwards |
First Address | Mesa, AZ 85203-8806 |
Second Address | Phoenix, AZ 85014-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2020 |
Last Update Date | 21/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
353569 | NATIONAL BOARD OF OCCUPATIONAL THERAPY (01) | AZ |