Provider Demographics
NPI:1164992913
Name:SEATON, GENITA (COTA)
Entity Type:Individual
Prefix:
First Name:GENITA
Middle Name:
Last Name:SEATON
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 1:14536 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60827-2638
Mailing Address - Country:US
Mailing Address - Phone:312-785-5280
Mailing Address - Fax:
Practice Address - Street 1:13820 S 44TH ST APT 1241
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4864
Practice Address - Country:US
Practice Address - Phone:312-785-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ410055224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant