Healthcare Provider Details

I. General information

NPI: 1326513680
Provider Name (Legal Business Name): MARYLEE BANZON CAWTHON MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1487 MARCHBANKS DR APT 3
WALNUT CREEK CA
94598-2045
US

IV. Provider business mailing address

1487 MARCHBANKS DR APT 3
WALNUT CREEK CA
94598-2045
US

V. Phone/Fax

Practice location:
  • Phone: 209-275-0034
  • Fax:
Mailing address:
  • Phone: 209-275-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number16033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: