Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 000036 | AZ |
NPI | 1487313219 |
---|---|
Provider Name | Jordan Jones |
First Address | Phoenix, AZ 85022-1982 |
Second Address | Phoenix, AZ 85032-2103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2021 |
Last Update Date | 09/12/2021 |