Provider Demographics
NPI:1558419820
Name:THUENEN, JUDY ANNE (OTRL)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANNE
Last Name:THUENEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:ANNE
Other - Last Name:BERTHEL-THUENEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:2831 E DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-6944
Mailing Address - Country:US
Mailing Address - Phone:480-830-0796
Mailing Address - Fax:
Practice Address - Street 1:1025 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3307
Practice Address - Country:US
Practice Address - Phone:480-472-6160
Practice Address - Fax:480-472-6192
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ580242Medicaid