Individual
JIYEA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10165 E HAMPTON AVE STE 111, MESA, AZ 85209-3327
(480) 354-5424
Mailing address
631 W PANTERA AVE, MESA, AZ 85210-8320
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
12/14/2020
Last updated
12/14/2020
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