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NPI Code Detail

MEDICARE: JAMAE' KMAK MS OTR/L

MEDICARE: JAMAE' KMAK MS OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1252Y00000XEarly Intervention Provider Agency5945AZ

General Provider Information

NPI Number : 1558763532
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMAE' KMAK MS OTR/L
Provider Business Mailing Address
First Line : 140 E CORAL GABLES DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85022-3690
Country : US
Telephone Number : 602-290-4880
Fax Number :
Provider Business Practice Location Address
First Line : 17300 N 88TH AVE
Second Line :
City : PEORIA
State : AZ
Zip : 85382-3501
Country : US
Telephone Number : 602-290-4880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2014
Last Update Date : 04/24/2024

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