Provider Demographics
NPI:1235737834
Name:OWENS, MARA JANE (COTA/L)
Entity type:Individual
Prefix:MS
First Name:MARA
Middle Name:JANE
Last Name:OWENS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4618
Mailing Address - Country:US
Mailing Address - Phone:602-595-2763
Mailing Address - Fax:
Practice Address - Street 1:7550 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4618
Practice Address - Country:US
Practice Address - Phone:602-371-4165
Practice Address - Fax:602-371-4121
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0127224Z00000X
AZ0297224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant