Provider Demographics
NPI:1548972433
Name:AMMOSCATO, JORDAN ELISABETH (OTR)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELISABETH
Last Name:AMMOSCATO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 E MAYO BLVD UNIT 2023
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4512
Mailing Address - Country:US
Mailing Address - Phone:602-501-3986
Mailing Address - Fax:
Practice Address - Street 1:5040 E SHEA BLVD STE 168
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4686
Practice Address - Country:US
Practice Address - Phone:480-483-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist