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NPI Code Detail

MEDICARE: MRS. KATELYN R SANDERSON COTA/L

MEDICARE: MRS. KATELYN R SANDERSON COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant2679CA
2224Z00000XOccupational Therapy Assistant32002451AIN

General Provider Information

NPI Number : 1144659095
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATELYN R SANDERSON COTA/L
Provider Business Mailing Address
First Line : 69764 HILLTOP RD
Second Line :
City : UNION
State : MI
Zip : 49130-9711
Country : US
Telephone Number : 574-596-5296
Fax Number :
Provider Business Practice Location Address
First Line : 637 E ROMIE LN
Second Line :
City : SALINAS
State : CA
Zip : 93901-4205
Country : US
Telephone Number : 831-424-0687
Fax Number : 831-424-1363
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2013
Last Update Date : 11/01/2013

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