Individual
JUDY PATRICIA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2425 NIETO WAY, MEDFORD, OR 97504-8577
(253) 255-3046
Mailing address
2425 NIETO WAY, MEDFORD, OR 97504-8577
(253) 255-3046
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
280341
OR
Other
Enumeration date
10/24/2015
Last updated
10/24/2015
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