Provider Demographics
NPI:1407534613
Name:MA'AE, MARIAH (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:MA'AE
Suffix:
Gender:F
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 1:1034 E CARSON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3640
Mailing Address - Country:US
Mailing Address - Phone:562-972-2629
Mailing Address - Fax:
Practice Address - Street 1:4755 KATELLA AVE APT 101
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90720-1903
Practice Address - Country:US
Practice Address - Phone:714-908-9917
Practice Address - Fax:657-223-8268
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA6363224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant