Individual
JESSICA MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
3941 E BASELINE RD STE 101, GILBERT, AZ 85234-2750
(480) 787-5387
(480) 320-3537
Mailing address
9150 W INDIAN SCHOOL RD STE 130, PHOENIX, AZ 85037-2388
(480) 787-5387
(623) 232-3250
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTH-009572
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175024
—
AZ
Enumeration date
09/23/2024
Last updated
02/14/2025
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