Provider Demographics
NPI:1619391794
Name:BURRAGE, PATRICIA MAE (COTA/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MAE
Last Name:BURRAGE
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 1:319 E MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2363
Mailing Address - Country:US
Mailing Address - Phone:480-628-0124
Mailing Address - Fax:
Practice Address - Street 1:319 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2363
Practice Address - Country:US
Practice Address - Phone:480-628-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA046787224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant