Provider Demographics
NPI:1306234844
Name:MAGETO, JASON (COTA/L)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:MAGETO
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:ATENGA
Other - Last Name:MAGETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:2825 N STATE HIGHWAY 360
Mailing Address - Street 2:APT 141
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-7842
Mailing Address - Country:US
Mailing Address - Phone:316-305-8012
Mailing Address - Fax:
Practice Address - Street 1:721 DUNAWAY LN
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2605
Practice Address - Country:US
Practice Address - Phone:817-444-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212165224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant