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General NPI Number Information
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NPI Number | 1669234522
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Entity Type | Individual
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Provider Name | SANDRA DIANNE SHIVELY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 1901 E HAMILTON ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-3904
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Country | US
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Telephone | 660-626-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 4067 SHELBY 357
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City | SHELBYVILLE
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State | MO
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Zip | 63469-2531
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Country | US
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Telephone | 573-501-0292
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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 | 2015001725
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License Number State | MO
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