Provider Demographics
NPI:1245919273
Name:INADA, MARISA AZI EIKO (OTD, OTR, OTLL)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:AZI EIKO
Last Name:INADA
Suffix:
Gender:F
Credentials:OTD, OTR, OTLL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 E GUADALUPE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3266
Mailing Address - Country:US
Mailing Address - Phone:480-699-4845
Mailing Address - Fax:480-699-5085
Practice Address - Street 1:3961 E GUADALUPE RD STE 1
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-3266
Practice Address - Country:US
Practice Address - Phone:480-699-4845
Practice Address - Fax:480-699-5085
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTLL-000059225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist