Mary Ann Mendoza De Guzman, OT

Primary specialty

Gerontology Occupational TherapistTaxonomy code 225XG0600X

License

OT-906 Issued in ID

Practice address

1200 Hospital Way
Pocatello, ID 83201-2708

Phone

(208) 232-2570

NPI assigned

Mar 15, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300147200000",
    "number": "1376842419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2535 WOODHILL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012613",
            "telephone_number": "208-233-1679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012708",
            "telephone_number": "208-232-2570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE GUZMAN",
        "first_name": "MARY ANN",
        "middle_name": "MENDOZA",
        "name_prefix": "Mrs.",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-15",
        "last_updated": "2011-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "ID",
            "license": "OT-906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sage Davis, PHARMD
• Stephanie Ann Davis, MOTR/L
• Thomas Vance Davis, D.O.
• Myla Day, LMSW
• Bo Dayton, DO
• Robert Andrew De Wall, LCPC
• Justin Dechon
• McKenzie Jo Decker, DNP
• Sherry Deiter
• Ruth Siobhan Dekker, M.S.N., F.N.P.

• All providers in Pocatello, ID
• Gerontology Occupational Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; 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.