Provider Demographics
NPI:1487990735
Name:MASON, PHYLLIS ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ANN
Last Name:MASON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1291
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-0197
Mailing Address - Country:US
Mailing Address - Phone:509-760-6948
Mailing Address - Fax:
Practice Address - Street 1:3057 ROAD H NE
Practice Address - Street 2:#49
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-9609
Practice Address - Country:US
Practice Address - Phone:509-760-6948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000635224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant