Healthcare Provider Details

I. General information

NPI: 1134858384
Provider Name (Legal Business Name): SARAH ELIZABETH JOHNSTON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ELIZABETH ROBERDS

II. Dates (important events)

Enumeration Date: 06/05/2022
Last Update Date: 06/05/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5943 TELEGRAPH RD
SAINT LOUIS MO
63129-4715
US

IV. Provider business mailing address

2187 SILVER SPRINGS DR
BONNE TERRE MO
63628-3887
US

V. Phone/Fax

Practice location:
  • Phone: 314-846-2000
  • Fax:
Mailing address:
  • Phone: 573-631-7468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2022006677
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: