Provider Demographics
NPI:1255546651
Name:CAPOBIANCO, JENNIFER (COTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CAPOBIANCO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15757 N 90TH PL
Mailing Address - Street 2:#2073
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2002
Mailing Address - Country:US
Mailing Address - Phone:520-834-6244
Mailing Address - Fax:
Practice Address - Street 1:10235 S 51ST ST
Practice Address - Street 2:STE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5218
Practice Address - Country:US
Practice Address - Phone:480-889-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0887224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant