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General NPI Number Information
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NPI Number | 1427677533
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Entity Type | Individual
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Provider Name | SARA LYNN DODSWORTH COTA/L
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Gender | Female
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 600 2ND AVE
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City | NEW GLARUS
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State | WI
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Zip | 53574-9776
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Country | US
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Telephone | 608-527-4390
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 PARK ST APT 3
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City | BLACK EARTH
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State | WI
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Zip | 53515-9510
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Country | US
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Telephone | 303-656-8349
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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 | 5699-27
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License Number State | WI
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