Healthcare Provider Details

I. General information

NPI: 1467679308
Provider Name (Legal Business Name): JAYSI MADIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 N 24TH ST
PHOENIX AZ
85008-1004
US

IV. Provider business mailing address

2850 N 24TH ST
PHOENIX AZ
85008-1004
US

V. Phone/Fax

Practice location:
  • Phone: 602-266-5976
  • Fax: 602-274-8952
Mailing address:
  • Phone: 602-266-5976
  • Fax: 602-274-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3101
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: