Healthcare Provider Details

I. General information

NPI: 1073566113
Provider Name (Legal Business Name): STEPHEN S DESJARDINS OTR/L, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6626 E 2ND ST
SCOTTSDALE AZ
85251-5210
US

IV. Provider business mailing address

6626 E 2ND ST
SCOTTSDALE AZ
85251-5210
US

V. Phone/Fax

Practice location:
  • Phone: 602-451-7924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number2613
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: