Healthcare Provider Details

I. General information

NPI: 1568790731
Provider Name (Legal Business Name): SANDRA J PLISKA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 S ARIZONA AVE
YUMA AZ
85364-8520
US

IV. Provider business mailing address

13376 E 38TH ST
YUMA AZ
85367-5843
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-8541
  • Fax:
Mailing address:
  • Phone: 928-210-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1855
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: