MEDICARE: DEERING THERAPY SERVICES LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5470960001	OTHER	AZ	DMERC

General Provider Information

NPI Number	:	1083865737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEERING THERAPY SERVICES LTD

Provider Business Mailing Address
First Line	:	PO BOX 3278
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86402-3278
Country	:	US
Telephone Number	:	928-753-4263
Fax Number	:	928-753-1173

Provider Business Practice Location Address
First Line	:	2501 STOCKTON HILL RD
Second Line	:	SUITE 104
City	:	KINGMAN
State	:	AZ
Zip	:	86401-4140
Country	:	US
Telephone Number	:	928-753-4263
Fax Number	:	928-753-1173

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KERRY WAYNE DEERING
Credential	:	OTR
Telephone Number	:	928-753-4263

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	09/30/2008

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