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General NPI Number Information
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NPI Number | 1558764969
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Entity Type | Individual
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Provider Name | SONJA E HUPP COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 1210 13TH ST
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City | PARKERSBURG
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State | WV
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Zip | 26101-4144
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Country | US
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Telephone | 304-420-9655
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Fax |
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Provider Business Mailing Address
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Address Line | 11 BELAVISTA DR
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City | MARIETTA
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State | OH
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Zip | 45750-8226
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Country | US
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Telephone | 740-629-2474
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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 | C1572
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA 01204
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License Number State | OH
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