Provider Demographics
NPI:1265613475
Name:WRIGHT, JANIS LOUISE (OTR/L)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:LOUISE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:LOUISE
Other - Last Name:POWELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1331 LOREN DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-2875
Mailing Address - Country:US
Mailing Address - Phone:928-541-7606
Mailing Address - Fax:928-541-7606
Practice Address - Street 1:HWY 264 AND US 191
Practice Address - Street 2:GANADO UNIFIED SCHOOL DISTRICT #20
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505
Practice Address - Country:US
Practice Address - Phone:928-755-1020
Practice Address - Fax:928-755-1022
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2755225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist