Provider Demographics
NPI:1952535759
Name:DEERFIELD, JODI NELSON (CTRS)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:NELSON
Last Name:DEERFIELD
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 N MARBURG PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3818
Mailing Address - Country:US
Mailing Address - Phone:208-863-2409
Mailing Address - Fax:
Practice Address - Street 1:2305 N MARBURG PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-3818
Practice Address - Country:US
Practice Address - Phone:208-863-2409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist