Provider Demographics
NPI:1235501644
Name:DIEGO, MAGALY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MAGALY
Middle Name:
Last Name:DIEGO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:MAGALY
Other - Middle Name:
Other - Last Name:SOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:WA
Mailing Address - Zip Code:99321-0359
Mailing Address - Country:US
Mailing Address - Phone:509-790-8174
Mailing Address - Fax:
Practice Address - Street 1:1100 E NELSON RD
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2360
Practice Address - Country:US
Practice Address - Phone:509-765-6788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-25
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60592198224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant