Individual provider Active NPI

Mary Udria, COTA/L

  • Occupational Therapy Assistant
  • San Dimas, CA
National Provider Identifier
1104774710
Registry record updated Mar 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA121 Issued in CA
Practice address
740 E Allen Ave
San Dimas, CA 91773-1545
Phone
(909) 971-8202
NPI assigned
Mar 19, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA121 CA Primary

Addresses

Primary practice location

740 E Allen Ave
San Dimas, CA 91773-1545

Mailing address

115 W Allen Ave
San Dimas, CA 91773-1437
Phone (909) 971-8200

Other practice location 1

2715 E St
LA Verne, CA 91750-4510
Phone (909) 971-8207

Other practice location 2

1629 Holly Oak St
LA Verne, CA 91750-3914
Phone (909) 971-8206

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OTA121CAMDOccupational Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1773878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773878400000",
    "number": "1104774710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W ALLEN AVE",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731437",
            "telephone_number": "909-971-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 E ALLEN AVE",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731545",
            "telephone_number": "909-971-8202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2715 E St",
            "address_purpose": "LOCATION",
            "city": "LA Verne",
            "state": "CA",
            "postal_code": "917504510",
            "country_code": "US",
            "telephone_number": "909-971-8207",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1629 Holly Oak St",
            "address_purpose": "LOCATION",
            "city": "LA Verne",
            "state": "CA",
            "postal_code": "917503914",
            "country_code": "US",
            "telephone_number": "909-971-8206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UDRIA",
        "first_name": "MARY",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-03-19",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CA",
            "license": "OTA121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Dimas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.