Basic Information
| Provider Information | |||||||||
| NPI: | 1508085697 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FENLEY | ||||||||
| FirstName: | JOSELYN | ||||||||
| MiddleName: | STURGIS | ||||||||
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| Credential: | MOTL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3359 E SWISS RD | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860042241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285290191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3150 N WINDING BROOK RD | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860010972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287747106 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2804 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 107843 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.