Provider Demographics
NPI:1043782105
Name:LOVETT, SAMBRIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:SAMBRIA
Middle Name:
Last Name:LOVETT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 WAR EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-2566
Mailing Address - Country:US
Mailing Address - Phone:229-395-6336
Mailing Address - Fax:
Practice Address - Street 1:405 LAUREL ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-3030
Practice Address - Country:US
Practice Address - Phone:229-543-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002404224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant