Healthcare Provider Details

I. General information

NPI: 1487449971
Provider Name (Legal Business Name): MCKENNA JO KUHLMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 E RAY RD STE 101A
PHOENIX AZ
85044-4707
US

IV. Provider business mailing address

4350 E RAY RD STE 101A
PHOENIX AZ
85044-4707
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-5954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: