Provider Demographics
NPI:1275180051
Name:AYERS, MARIANNA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:AYERS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:MARIANNA
Other - Middle Name:
Other - Last Name:SORDILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1330 ARNOLD DR STE 148
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6538
Mailing Address - Country:US
Mailing Address - Phone:925-310-6311
Mailing Address - Fax:
Practice Address - Street 1:1330 ARNOLD DR STE 148
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-6538
Practice Address - Country:US
Practice Address - Phone:925-310-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA22163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor