Healthcare Provider Details

I. General information

NPI: 1487577813
Provider Name (Legal Business Name): MARIAH PORATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 JIM COTTRELL CIRCLE
PALMER AK
99645
US

IV. Provider business mailing address

PO BOX 876104
WASILLA AK
99687-6104
US

V. Phone/Fax

Practice location:
  • Phone: 907-214-1968
  • Fax:
Mailing address:
  • Phone: 907-214-1968
  • Fax: 866-283-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: