Healthcare Provider Details

I. General information

NPI: 1588266894
Provider Name (Legal Business Name): ALISON MARIE KOTOWSKI MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19389 N 59TH AVE
GLENDALE AZ
85308-6500
US

IV. Provider business mailing address

7523 W ALEXANDRIA WAY
PEORIA AZ
85381-8549
US

V. Phone/Fax

Practice location:
  • Phone: 623-572-3631
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5016
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: