Provider Demographics
NPI:1417082256
Name:VIRNIG, JEAN (OTRL)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:VIRNIG
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 E INDIAN SCHOOL RD
Mailing Address - Street 2:APT C319
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6369
Mailing Address - Country:US
Mailing Address - Phone:423-544-6699
Mailing Address - Fax:
Practice Address - Street 1:1830 S ALMA SCHOOL RD
Practice Address - Street 2:STE 130
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3056
Practice Address - Country:US
Practice Address - Phone:480-902-0771
Practice Address - Fax:480-967-0804
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT436225XP0200X, 225X00000X
AZ5568225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist