Provider Demographics
NPI:1225819881
Name:COLYAR, TATE (OT/COTA)
Entity Type:Individual
Prefix:
First Name:TATE
Middle Name:
Last Name:COLYAR
Suffix:
Gender:M
Credentials:OT/COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13565 W BRILES RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-8296
Mailing Address - Country:US
Mailing Address - Phone:623-385-6692
Mailing Address - Fax:
Practice Address - Street 1:13811 N 35TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5500
Practice Address - Country:US
Practice Address - Phone:623-206-1826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-006763225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist