Individual
JENNIFER DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2401 E HUNT DR, SHOW LOW, AZ 85901-7920
(928) 537-5333
Mailing address
2401 E HUNT DR, SHOW LOW, AZ 85901-7920
(928) 537-5333
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
6718
AZ
Other
Enumeration date
11/16/2016
Last updated
11/16/2016
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