Jason Wooden
Individual provider Active NPI Occupational Therapist · Glebdale, AZ
NPI 1699168906 · NPPES record last updated Mar 11, 2015
Key facts
- NPI
- 1699168906
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 3291 (AZ)
- Practice address
- 17505 N. 79TH Ave
Glebdale, AZ 85308 - Phone
- (623) 979-5266
- NPI assigned
- Mar 11, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3291 | AZ | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arizona Post-Acute Medical Services 1 PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 3291 | AZ | Yes |
Addresses
Primary practice location
17505 N. 79TH Ave
Glebdale, AZ 85308
Mailing address
17505 N. 79TH Ave
Glebdale, AZ 85308
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.