Provider Demographics
NPI:1295012714
Name:UMSTOT, SONYA L (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:L
Last Name:UMSTOT
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 1:610 N FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7216
Mailing Address - Country:US
Mailing Address - Phone:301-729-0774
Mailing Address - Fax:
Practice Address - Street 1:610 N FOURTH ST
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7216
Practice Address - Country:US
Practice Address - Phone:301-729-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007064224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant