Provider Demographics
NPI:1063847572
Name:ADY, MARY TEKLA (COTA)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:TEKLA
Last Name:ADY
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 1:945 MCGILCHRIST ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2126
Mailing Address - Country:US
Mailing Address - Phone:503-586-3097
Mailing Address - Fax:
Practice Address - Street 1:945 MCGILCHRIST ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2126
Practice Address - Country:US
Practice Address - Phone:503-586-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2618224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant