Mary Colleen Fortis, O.T.

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT3899 Issued in CA

Practice address

2025 Soquel Ave
Santa Cruz, CA 95062-1323

Phone

(831) 423-4111

NPI assigned

Dec 11, 2006

Sex

Female

Sole proprietor

No

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)

Enrolled

State licenses

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1740340660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1833",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950611833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 SOQUEL AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950621323",
            "telephone_number": "831-423-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTIS",
        "first_name": "MARY",
        "middle_name": "COLLEEN",
        "credential": "O.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "OT3899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Payton Ford
• Forefront Dermatology - Pacific, P.C.
• Kasha Marie Forgette, LAC, CMT
• Alicia M Foronda, LMFT
• G Vaughn Forsyth
• Audra T Foster, NATUROPATHIC
• Sarah J Foster, M.S., CCC-SLP
• Foundation Chiropractic, a Ritola Professional Corporation
• Emma Foutch
• Robin Kristina Fox, RPA

• Occupational Therapist in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; 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.