Provider Demographics
NPI:1487996104
Name:HORTON, JENNIFER (COTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14753 W ALEXANDRIA WAY
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4233
Mailing Address - Country:US
Mailing Address - Phone:602-568-0970
Mailing Address - Fax:
Practice Address - Street 1:14753 W ALEXANDRIA WAY
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4233
Practice Address - Country:US
Practice Address - Phone:602-568-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2023-08-29
Deactivation Date:2015-05-06
Deactivation Code:
Reactivation Date:2018-04-13
Provider Licenses
StateLicense IDTaxonomies
AZ4931224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant