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General NPI Number Information
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NPI Number | 1023724085
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Entity Type | Individual
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Provider Name | JAZZ TAYLOR WHITE MOTR/L
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Gender | Male
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 13385 W MCDOWELL RD
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City | GOODYEAR
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State | AZ
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Zip | 85395-2631
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Country | US
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Telephone | 623-986-5110
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Fax |
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Provider Business Mailing Address
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Address Line | 4222 S 186TH AVE
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City | GOODYEAR
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State | AZ
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Zip | 85338-7974
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Country | US
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Telephone | 801-649-7025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 009039
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License Number State | AZ
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