Healthcare Provider Details

I. General information

NPI: 1861171985
Provider Name (Legal Business Name): ZHANE KEIANA PAYAN-STRAUGHTER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 N 19TH AVE
PHOENIX AZ
85021-8585
US

IV. Provider business mailing address

1033 S MARIANA ST APT 2
TEMPE AZ
85281-4174
US

V. Phone/Fax

Practice location:
  • Phone: 602-601-2401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-047177
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: