Basic Information
| Provider Information | |||||||||
| NPI: | 1417076027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEER VALLEY UNIFIED SCHOOL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7048 W EAGLE RIDGE LN | ||||||||
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| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853833041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238251489 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20402 N 15TH AVE | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850273636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234454952 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 09/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | WELLS | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | HR | ||||||||
| AuthorizedOfficialTelephone: | 6234454952 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 2848 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.