Provider Demographics
NPI:1942329198
Name:OCCUPATIONAL THERAPY SERVICES OF VERDE VALLEY, INC.
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY SERVICES OF VERDE VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:928-634-0488
Mailing Address - Street 1:897 COVE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6516
Mailing Address - Country:US
Mailing Address - Phone:928-634-0488
Mailing Address - Fax:928-634-0757
Practice Address - Street 1:897 COVE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6516
Practice Address - Country:US
Practice Address - Phone:928-634-0488
Practice Address - Fax:928-634-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0089261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0290670OtherBCBS AZ
AZ771239OtherAHCCCS
AZ0290670OtherBCBS AZ
AZZ65521Medicare PIN