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General NPI Number Information
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NPI Number | 1205659034
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Entity Type | Individual
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Provider Name | JAQUELINE MARTINEZ OLIVARES COTA/L
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1951 W CAMELBACK RD STE 450
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City | PHOENIX
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State | AZ
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Zip | 85015-3474
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Country | US
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Telephone | 480-530-0890
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Fax |
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Provider Business Mailing Address
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Address Line | 6580 E MCDOWELL RD UNIT 1401
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-0024
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Country | US
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Telephone | 480-645-4597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA-050111
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License Number State | AZ
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