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General NPI Number Information
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NPI Number | 1801360276
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Entity Type | Individual
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Provider Name | DIANA ROUTKEVICH COTA/L
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Gender | Female
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 5270 ELVAS AVE
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City | SACRAMENTO
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State | CA
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Zip | 95819-2332
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Country | US
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Telephone | 916-905-0902
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 277233
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City | SACRAMENTO
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State | CA
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Zip | 95827-7233
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Country | US
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Telephone | 916-803-1489
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OTA4471
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License Number State | CA
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