Healthcare Provider Details

I. General information

NPI: 1558004432
Provider Name (Legal Business Name): SAKAOWRAT YIOTIS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46531 HARRY BYRD HWY
STERLING VA
20164-3555
US

IV. Provider business mailing address

42274 SAND PINE PL
CHANTILLY VA
20152-4156
US

V. Phone/Fax

Practice location:
  • Phone: 703-834-5800
  • Fax:
Mailing address:
  • Phone: 703-966-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: