Healthcare Provider Details

I. General information

NPI: 1538503776
Provider Name (Legal Business Name): MARLA PRYOR C.O.T.A./L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 CLEVELAND AVE
KANSAS CITY MO
64132-1622
US

IV. Provider business mailing address

285 NE ADAMS DAIRY PKWY
BLUE SPRINGS MO
64014-5450
US

V. Phone/Fax

Practice location:
  • Phone: 816-444-5327
  • Fax:
Mailing address:
  • Phone: 816-977-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2007026366
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: