Provider Demographics
NPI:1336358936
Name:MARIOTA, KERRY M (OTR, CHT)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:M
Last Name:MARIOTA
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 TRAILRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-4066
Mailing Address - Country:US
Mailing Address - Phone:619-740-5225
Mailing Address - Fax:619-589-7638
Practice Address - Street 1:9000 WAKARUSA ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3307
Practice Address - Country:US
Practice Address - Phone:619-740-4600
Practice Address - Fax:619-589-7638
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2899225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand