Provider Demographics
NPI:1730551482
Name:MCGINNIS, MARJORIE ELAINE (COTA)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ELAINE
Last Name:MCGINNIS
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 1:1601 N TUCSON BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3404
Mailing Address - Country:US
Mailing Address - Phone:520-829-9635
Mailing Address - Fax:520-829-9636
Practice Address - Street 1:1601 N TUCSON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3404
Practice Address - Country:US
Practice Address - Phone:520-829-9635
Practice Address - Fax:520-829-9636
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4816174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist