Individual
MR. GEORGE JAMES MATA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
10251 N 35TH AVE, PHOENIX, AZ 85051-1305
(602) 995-0867
Mailing address
222 W CLARENDON AVE APT 207, APT #207, PHOENIX, AZ 85013-3487
(602) 516-0162
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1917
AZ
Other
Enumeration date
02/08/2007
Last updated
01/05/2015
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