Provider Demographics
NPI:1407906951
Name:JIMENEZ, JODY J (COTA)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:J
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 S 206TH DR
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-9502
Mailing Address - Country:US
Mailing Address - Phone:602-291-3901
Mailing Address - Fax:
Practice Address - Street 1:22150 W SUNDANCE PKWY
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-5560
Practice Address - Country:US
Practice Address - Phone:623-327-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2683224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant