Provider Demographics
NPI:1538839469
Name:ASCHWANDEN, MARY LYNN (COTA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:ASCHWANDEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 N ARVADA
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-5433
Mailing Address - Country:US
Mailing Address - Phone:720-841-0086
Mailing Address - Fax:
Practice Address - Street 1:63 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7417
Practice Address - Country:US
Practice Address - Phone:480-472-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ046936224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant