Provider Demographics
NPI:1598977365
Name:PEET, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:PEET
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 1:554 E MAGEE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7231
Mailing Address - Country:US
Mailing Address - Phone:520-797-1572
Mailing Address - Fax:520-219-3607
Practice Address - Street 1:4710 E 29TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-6447
Practice Address - Country:US
Practice Address - Phone:520-745-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAHCCCS 770554OtherAZ LONG TERM CARE