Provider Demographics
NPI:1528264769
Name:SCHEUNEMANN, JOAN DELORES (OT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:DELORES
Last Name:SCHEUNEMANN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16633 N 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3077
Mailing Address - Country:US
Mailing Address - Phone:602-866-2454
Mailing Address - Fax:
Practice Address - Street 1:16633 N 30TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3077
Practice Address - Country:US
Practice Address - Phone:602-866-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0346225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ26674Medicare ID - Type Unspecified