Active NPI
Mallory Manson, COTA/L
- Occupational Therapy Assistant
- Peoria, AZ
National Provider Identifier
1952656282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA.004152
- Practice address
- 8624 W Sweetwater Ave
Peoria, AZ 85381-8101 - Phone
- (623) 412-4850
- NPI assigned
- Jul 24, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OTA.004152 | OH | Primary |
Addresses
Primary practice location
8624 W Sweetwater Ave
Peoria, AZ 85381-8101
Mailing address
4600 E Shea Blvd Ste 101
Phoenix, AZ 85028-6031
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
| License | State | Type | Specialty |
|---|---|---|---|
| OTA.004152 | OH | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616112000000",
"number": "1952656282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4600 E SHEA BLVD STE 101",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850286031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8624 W SWEETWATER AVE",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853818101",
"telephone_number": "623-412-4850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSON",
"first_name": "MALLORY",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-24",
"last_updated": "2021-03-19",
"certification_date": "2021-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "OH",
"license": "OTA.004152",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.