Provider Demographics
NPI:1184885394
Name:RITTER, MARK ALLAN (OTR/L)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLAN
Last Name:RITTER
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:505 JACKS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-7856
Mailing Address - Country:US
Mailing Address - Phone:928-284-2411
Mailing Address - Fax:928-284-2439
Practice Address - Street 1:505 JACKS CANYON RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-7856
Practice Address - Country:US
Practice Address - Phone:928-284-2411
Practice Address - Fax:928-284-2439
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2123225XH1200X, 225XN1300X, 225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility