Provider Demographics
NPI:1215404587
Name:MAKI, TIMARIE FAY (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TIMARIE
Middle Name:FAY
Last Name:MAKI
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 1:9415 N 99TH AVE APT 2042
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6939
Mailing Address - Country:US
Mailing Address - Phone:916-588-5206
Mailing Address - Fax:
Practice Address - Street 1:9415 N 99TH AVE APT 2042
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6939
Practice Address - Country:US
Practice Address - Phone:916-588-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD10289718224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ224Z00000XMedicaid