Healthcare Provider Details

I. General information

NPI: 1699308270
Provider Name (Legal Business Name): JODI EILEEN EDWARDS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI EILEEN SALVI, REIMER

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 E MISSOURI AVE STE 100
PHOENIX AZ
85014-2719
US

IV. Provider business mailing address

6 N FRASER DR
MESA AZ
85203-8806
US

V. Phone/Fax

Practice location:
  • Phone: 602-393-0520
  • Fax:
Mailing address:
  • Phone: 480-203-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number353569
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: