Healthcare Provider Details

I. General information

NPI: 1154241370
Provider Name (Legal Business Name): JOHN IVER AGONOY OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E BANNER GATEWAY DR STE 200
GILBERT AZ
85234-2171
US

IV. Provider business mailing address

450 E BARBARA DR
TEMPE AZ
85288-1411
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-2908
  • Fax:
Mailing address:
  • Phone: 619-990-5819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTH-009173
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-009173
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: