Healthcare Provider Details

I. General information

NPI: 1336387349
Provider Name (Legal Business Name): DRIVING TO INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W BROADWAY RD SUITE 218
TEMPE AZ
85282-1133
US

IV. Provider business mailing address

1414 W BROADWAY RD SUITE 218
TEMPE AZ
85282-1133
US

V. Phone/Fax

Practice location:
  • Phone: 480-449-3331
  • Fax: 480-753-9428
Mailing address:
  • Phone: 480-449-3331
  • Fax: 480-753-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number281
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number281
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number281
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number281
License Number StateAZ

VIII. Authorized Official

Name: JENNIFER NORDINE
Title or Position: OWNER
Credential: OTR/L, CDRS
Phone: 480-449-3331