Individual
EZINNE MBATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
8410 BUSTLETON AVE APT G18, PHILADELPHIA, PA 19152-1917
(215) 554-7125
Mailing address
8410 BUSTLETON AVE APT G18, PHILADELPHIA, PA 19152-1917
(215) 554-7125
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP008368
PA
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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