Provider Demographics
NPI:1306206032
Name:GARRETT, NATHAN (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:GARRETT
Suffix:
Gender:M
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 1:854 W CAROLINE LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4372
Mailing Address - Country:US
Mailing Address - Phone:480-225-9209
Mailing Address - Fax:
Practice Address - Street 1:8700 S KYRENE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2108
Practice Address - Country:US
Practice Address - Phone:480-225-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6407390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program