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General NPI Number Information
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NPI Number | 1922582253
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Entity Type | Individual
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Provider Name | SANDRA LEE DIZENZO COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/22/2018
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Last Update Date | 09/22/2018
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Provider Practice Location Address
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Address Line | 88 NOTCH HILL RD
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City | NORTH BRANFORD
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State | CT
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Zip | 06471-1846
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Country | US
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Telephone | 203-488-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 5 S COVE RD
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-2585
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Country | US
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Telephone | 860-391-8444
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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 | 001041
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License Number State | CT
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