Provider Demographics
NPI:1518089622
Name:ATHNOS, DEANNA ELIZABETH
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:ELIZABETH
Last Name:ATHNOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 E CLINTON ST
Mailing Address - Street 2:APT 2036
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5802
Mailing Address - Country:US
Mailing Address - Phone:406-531-6463
Mailing Address - Fax:
Practice Address - Street 1:4650 W. SWEETWATER AVE.
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:602-347-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3318225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist