Provider Demographics
NPI:1881897007
Name:TOWELL, MARY M (OTRL)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:TOWELL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45631 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6013
Mailing Address - Country:US
Mailing Address - Phone:951-308-1837
Mailing Address - Fax:951-308-1837
Practice Address - Street 1:45631 MASTERS DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6013
Practice Address - Country:US
Practice Address - Phone:951-308-1837
Practice Address - Fax:951-308-1837
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0T0003120OtherBLUE SHIELD OF CA
CAPJ0820OtherSAN DIEGO INLAND REGIONAL