Provider Demographics
NPI:1770307407
Name:COLLINS, RAYANNA MARIE (OTA-046959)
Entity type:Individual
Prefix:
First Name:RAYANNA
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OTA-046959
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 E ROLAND CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207
Mailing Address - Country:US
Mailing Address - Phone:949-374-2098
Mailing Address - Fax:
Practice Address - Street 1:7611 E ROLAND CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207
Practice Address - Country:US
Practice Address - Phone:949-374-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-046959225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist