Healthcare Provider Details

I. General information

NPI: 1376162743
Provider Name (Legal Business Name): JENNIFER LYNN CLAUSING OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 E UNION HILLS DR STE 110
PHOENIX AZ
85050-3389
US

IV. Provider business mailing address

4045 E UNION HILLS DR STE 110
PHOENIX AZ
85050-3389
US

V. Phone/Fax

Practice location:
  • Phone: 602-485-4444
  • Fax: 480-451-7780
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-008045
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTH-008045
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: