Healthcare Provider Details

I. General information

NPI: 1023629029
Provider Name (Legal Business Name): COURTNEY JIURA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 W BEARDSLEY RD
PEORIA AZ
85382-2652
US

IV. Provider business mailing address

12755 W MILTON DR
PEORIA AZ
85383-4413
US

V. Phone/Fax

Practice location:
  • Phone: 623-412-5400
  • Fax:
Mailing address:
  • Phone: 720-939-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3903
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: