Provider Demographics
NPI:1952899064
Name:EWALD, MARY KAY (OTR/L)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:EWALD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KAY
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:20715 E OCOTILLO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6118
Mailing Address - Country:US
Mailing Address - Phone:480-888-1558
Mailing Address - Fax:480-888-1533
Practice Address - Street 1:20715 E OCOTILLO RD STE 103
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6118
Practice Address - Country:US
Practice Address - Phone:480-888-1558
Practice Address - Fax:480-888-1533
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3275225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist