Provider Demographics
NPI:1194378414
Name:KABELLA, SONJA ANN (COTA)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:ANN
Last Name:KABELLA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 VENUE DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-4548
Mailing Address - Country:US
Mailing Address - Phone:817-771-7512
Mailing Address - Fax:
Practice Address - Street 1:10095 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5428
Practice Address - Country:US
Practice Address - Phone:850-479-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215239224Z00000X
GAOTA002454224Z00000X
FLOTA16802224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant