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General NPI Number Information
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NPI Number | 1568959146
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Entity Type | Individual
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Provider Name | MIA LYNN SANDATE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 1111 SUPERIOR AVE E STE 1800
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City | CLEVELAND
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State | OH
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Zip | 44114-2500
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Country | US
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Telephone | 216-883-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 BIDDULPH AVE
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City | CLEVELAND
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State | OH
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Zip | 44109-5018
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Country | US
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Telephone | 216-903-8433
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 10091
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License Number State | OH
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