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General NPI Number Information
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NPI Number | 1164762233
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Entity Type | Individual
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Provider Name | SARAH J MUSGRAVE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 3131 WESTERN AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-0951
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Country | US
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Telephone | 928-718-0781
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Fax | 928-718-1177
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Provider Business Mailing Address
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Address Line | 3740 E SHAEFFER AVE
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City | KINGMAN
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State | AZ
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Zip | 86409-2390
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Country | US
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Telephone | 928-692-3143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 4722
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License Number State | AZ
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