Provider Demographics
NPI:1922250422
Name:EARLY, MARY K (COTAL)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:EARLY
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
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Mailing Address - Street 1:3550 AIRPORT WAY
Mailing Address - Street 2:UNIT 4
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4760
Mailing Address - Country:US
Mailing Address - Phone:907-374-4911
Mailing Address - Fax:907-374-4934
Practice Address - Street 1:3550 AIRPORT WAY
Practice Address - Street 2:UNIT 4
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4760
Practice Address - Country:US
Practice Address - Phone:907-374-4911
Practice Address - Fax:907-374-4934
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK1850224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant