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General NPI Number Information
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NPI Number | 1396499570
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Entity Type | Individual
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Provider Name | SARA JEAN MIDDLETON COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 4547 PALISADES PARK VW
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-8697
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Country | US
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Telephone | 719-344-2482
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Fax |
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Provider Business Mailing Address
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Address Line | 4547 PALISADES PARK VW
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-8697
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Country | US
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Telephone | 719-344-2482
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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 | OTA.0000791
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License Number State | CO
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