Provider Demographics
NPI:1275103129
Name:WILLETT, SALLY (COTA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:WILLETT
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 1:4900 SHAMROCK DR STE 100-102
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7325
Mailing Address - Country:US
Mailing Address - Phone:812-479-7337
Mailing Address - Fax:812-550-1990
Practice Address - Street 1:4900 SHAMROCK DR STE 100-102
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7325
Practice Address - Country:US
Practice Address - Phone:812-479-7337
Practice Address - Fax:812-550-1990
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant