Provider Demographics
NPI:1013490820
Name:SPISHOCK, PILAR ELISE (COTA)
Entity Type:Individual
Prefix:
First Name:PILAR
Middle Name:ELISE
Last Name:SPISHOCK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:PILAR
Other - Middle Name:ELISE
Other - Last Name:RAYNOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6892 W MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1624
Mailing Address - Country:US
Mailing Address - Phone:602-615-7778
Mailing Address - Fax:
Practice Address - Street 1:4309 E FLORIAN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2798
Practice Address - Country:US
Practice Address - Phone:480-757-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-046628224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant