Individual
MR. JANSEN MINOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
4141 S HERRERA WAY, PHOENIX, AZ 85012-1814
(602) 248-1550
Mailing address
13570 W MARSHALL AVE, LITCHFIELD PARK, AZ 85340-3314
(765) 437-8573
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
6323
AZ
Other
Enumeration date
11/11/2015
Last updated
11/11/2015
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