Provider Demographics
NPI:1386989267
Name:JONES, MARY SHAYNE (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:SHAYNE
Last Name:JONES
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 1:2047 SWEET HOME CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-8705
Mailing Address - Country:US
Mailing Address - Phone:478-231-0163
Mailing Address - Fax:
Practice Address - Street 1:2047 SWEET HOME CHURCH RD
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-8705
Practice Address - Country:US
Practice Address - Phone:478-231-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001301224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant