MEDICARE: THEA MARIE MOTYKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1306664495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEA MARIE MOTYKA

Provider Business Mailing Address
First Line	:	PO BOX 10592
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85318-0592
Country	:	US
Telephone Number	:	602-456-9633
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 W JO ANN CIR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3307
Country	:	US
Telephone Number	:	602-456-9633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2024
Last Update Date	:	09/28/2024

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Directions to “ THEA MARIE MOTYKA ” Practice Location

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