Mary Anne Codilla, OTR/L

Primary specialty

Physical Rehabilitation Occupational TherapistTaxonomy code 225XP0019X

License

16295 Issued in CA

Practice address

4301 Caroline CT
Riverside, CA 92506-2902

Phone

(951) 683-7111

NPI assigned

Sep 16, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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": "1568592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568592000000",
    "number": "1649820226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6681 TANZANITE ST",
            "city": "JURUPA VALLEY",
            "state": "CA",
            "postal_code": "917524461",
            "telephone_number": "951-743-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 CAROLINE CT",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062902",
            "telephone_number": "951-683-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CODILLA",
        "first_name": "MARY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-16",
        "last_updated": "2019-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "CA",
            "license": "719842",
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "CA",
            "license": "16295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiara Cobbins
• Daniela Cobian
• David Cobian
• Paloma Cobian
• Coco Nicole Consulting
• Danielle Coe
• Michael James Coe, H.A.D.
• Kimberly Fern Coffee
• Cassandra Coffey, MS, BS, LPT
• Jasmin Coffey

• Physical Rehabilitation Occupational Therapist in Riverside, CA
• Providers in Riverside, CA by specialty
• Physical Rehabilitation Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; 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.