Healthcare Provider Details

I. General information

NPI: 1366585945
Provider Name (Legal Business Name): DEERING THERAPY SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 MORROW AVE
KINGMAN AZ
86409
US

IV. Provider business mailing address

PO BOX 3278
KINGMAN AZ
86409
US

V. Phone/Fax

Practice location:
  • Phone: 928-753-4263
  • Fax: 928-753-1173
Mailing address:
  • Phone: 928-753-4263
  • Fax: 928-753-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1689
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0104
License Number StateAZ

VIII. Authorized Official

Name: KERRY W. DEERING
Title or Position: PRESIDENT
Credential: OTR
Phone: 928-753-4263