Provider Demographics
NPI:1649362252
Name:MACHAIN, MARY ELLEN L (OTR)
Entity type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:L
Last Name:MACHAIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 E BENSON HWY
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-9074
Mailing Address - Country:US
Mailing Address - Phone:520-879-2000
Mailing Address - Fax:
Practice Address - Street 1:13801 E BENSON HWY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-9074
Practice Address - Country:US
Practice Address - Phone:520-879-2000
Practice Address - Fax:520-879-2000
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0236225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ771247Medicare ID - Type UnspecifiedAHCCCS