Provider Demographics
NPI:1851623839
Name:GUY, BERT (COTA)
Entity Type:Individual
Prefix:MR
First Name:BERT
Middle Name:
Last Name:GUY
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:CLAYTON
Other - Middle Name:ELBERT
Other - Last Name:GUY
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3320 ARROWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-6274
Mailing Address - Country:US
Mailing Address - Phone:928-854-3538
Mailing Address - Fax:
Practice Address - Street 1:7540 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7967
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4430224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant