Provider Demographics
NPI:1023223567
Name:ATEN, MARY A (OT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:ATEN
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 1:2603 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE C
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4724
Mailing Address - Country:US
Mailing Address - Phone:253-565-2939
Mailing Address - Fax:253-460-2613
Practice Address - Street 1:2603 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE C
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4724
Practice Address - Country:US
Practice Address - Phone:253-565-2939
Practice Address - Fax:253-460-2613
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002259225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA910598103OtherTAX IDENTIFICATION