Healthcare Provider Details

I. General information

NPI: 1033886916
Provider Name (Legal Business Name): SHARI LEE MOTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 BROADWAY ST
RICHVALE CA
95974-9597
US

IV. Provider business mailing address

PO BOX 3940
QUINCY CA
95971-3940
US

V. Phone/Fax

Practice location:
  • Phone: 707-599-6473
  • Fax:
Mailing address:
  • Phone: 530-283-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: