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General NPI Number Information
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NPI Number | 1932572062
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Entity Type | Individual
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Provider Name | JANSEN MINOR COTA/L
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Gender | Male
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 4141 S HERRERA WAY
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City | PHOENIX
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State | AZ
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Zip | 85012-1814
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Country | US
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Telephone | 602-248-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 13570 W MARSHALL AVE
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-3314
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Country | US
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Telephone | 765-437-8573
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 6323
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License Number State | AZ
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