Organization
GYM5
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE FOX (OWNER)
(480) 907-4956
Entity
Organization
Contact information
Practice address
6106 E WINDSTONE TRL, CAVE CREEK, AZ 85331-6058
(480) 907-4956
Mailing address
6106 E WINDSTONE TRL, CAVE CREEK, AZ 85331-6058
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
3442
AZ
Other
Enumeration date
07/12/2015
Last updated
07/12/2015
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