Healthcare Provider Details

I. General information

NPI: 1740304120
Provider Name (Legal Business Name): SANDRA LEA OWENS TOOMBS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 LOFTIN RD
COLUMBIA TN
38401
US

IV. Provider business mailing address

3976 BUCK MATTHEWS RD
COLUMBIA TN
38401
US

V. Phone/Fax

Practice location:
  • Phone: 931-380-1119
  • Fax:
Mailing address:
  • Phone: 931-840-5586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA0000000032
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: