Healthcare Provider Details

I. General information

NPI: 1871612861
Provider Name (Legal Business Name): JANICE LEE FRITSCHE OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 15TH ST RM306
DOUGLAS AZ
85607-1731
US

IV. Provider business mailing address

3400 W BLACKHAWK LN
DOUGLAS AZ
85607-6154
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-2447
  • Fax:
Mailing address:
  • Phone: 520-364-2094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0137
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: