Provider Demographics
NPI:1497916019
Name:WAY, LOUIS A (COTA)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:A
Last Name:WAY
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 E ASTRO ST
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-9644
Mailing Address - Country:US
Mailing Address - Phone:520-495-0788
Mailing Address - Fax:
Practice Address - Street 1:660 S CORONADO DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-3386
Practice Address - Country:US
Practice Address - Phone:520-459-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2314224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant