Provider Demographics
NPI:1992294326
Name:ORTIZ, JORDAN MARIE (COTA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 S TERESA DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4887
Mailing Address - Country:US
Mailing Address - Phone:480-433-6016
Mailing Address - Fax:
Practice Address - Street 1:6144 S TERESA DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-4887
Practice Address - Country:US
Practice Address - Phone:480-433-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6864224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant