Provider Demographics
NPI:1699308270
Name:EDWARDS, JODI EILEEN (OT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:EILEEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:EILEEN
Other - Last Name:SALVI, REIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 N FRASER DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8806
Mailing Address - Country:US
Mailing Address - Phone:480-203-8600
Mailing Address - Fax:
Practice Address - Street 1:1190 E MISSOURI AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2719
Practice Address - Country:US
Practice Address - Phone:602-393-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ353569225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ353569OtherNATIONAL BOARD OF OCCUPATIONAL THERAPY