Healthcare Provider Details

I. General information

NPI: 1366855603
Provider Name (Legal Business Name): JON CROSBY STANSFIELD OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4554 E INVERNESS AVE # C-1
MESA AZ
85206-4639
US

IV. Provider business mailing address

4554 E INVERNESS AVE # C-1
MESA AZ
85206-4639
US

V. Phone/Fax

Practice location:
  • Phone: 480-295-4925
  • Fax:
Mailing address:
  • Phone: 480-295-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License NumberOTH-007100
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: