Provider Demographics
NPI:1275973679
Name:JONES, KATIE M (COTA/L)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:CLONTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:533 S SEAWYNDS BLVD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6765
Mailing Address - Country:US
Mailing Address - Phone:480-299-2350
Mailing Address - Fax:
Practice Address - Street 1:533 S SEAWYNDS BLVD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-6765
Practice Address - Country:US
Practice Address - Phone:480-299-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5452224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant