Provider Demographics
NPI:1033881206
Name:RHODES, VICTORIA JAYNE (OTR)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JAYNE
Last Name:RHODES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4158 STONE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7151
Mailing Address - Country:US
Mailing Address - Phone:231-620-2076
Mailing Address - Fax:
Practice Address - Street 1:3627 E INDIAN SCHOOL RD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5159
Practice Address - Country:US
Practice Address - Phone:231-620-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist