Provider Demographics
NPI:1144583485
Name:MAZE, TOBI BUTLER (OTR)
Entity Type:Individual
Prefix:
First Name:TOBI
Middle Name:BUTLER
Last Name:MAZE
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 1:101 CONCORD RDG
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8940
Mailing Address - Country:US
Mailing Address - Phone:478-396-7275
Mailing Address - Fax:
Practice Address - Street 1:101 CONCORD RDG
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8940
Practice Address - Country:US
Practice Address - Phone:478-396-7275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005098225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125213AMedicaid