Individual
MR. JACKTON SIMIYU KHAUSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTRL
Contact information
Practice address
7255 E BROADWAY, MESA, AZ 85208
(480) 901-8844
Mailing address
3319 E UNIVERSITY DR, #341, MESA, AZ 85213
(480) 306-7503
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3955
AZ
Other
Enumeration date
09/11/2007
Last updated
09/11/2007
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