Healthcare Provider Details

I. General information

NPI: 1841447851
Provider Name (Legal Business Name): JODI DUECKER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 S RURAL RD
TEMPE AZ
85282-3853
US

IV. Provider business mailing address

1333 W AMANDA LN
TEMPE AZ
85284-3704
US

V. Phone/Fax

Practice location:
  • Phone: 480-730-7100
  • Fax:
Mailing address:
  • Phone: 480-705-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2429
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: