Provider Demographics
NPI:1134498702
Name:SANDERS-VEREEN, KEVIN DEWAYNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DEWAYNE
Last Name:SANDERS-VEREEN
Suffix:
Gender:M
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 1:3930 CLAIRMONT AVE S APT E
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3626
Mailing Address - Country:US
Mailing Address - Phone:205-283-2570
Mailing Address - Fax:
Practice Address - Street 1:3930 CLAIRMONT AVE S APT E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35222-3626
Practice Address - Country:US
Practice Address - Phone:205-283-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALOTA3101224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant