Provider Demographics
NPI:1356685754
Name:PERKINS, SANDRA KAY (COTA/L)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:PERKINS
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 1:2933 HIGHWAY 297
Mailing Address - Street 2:
Mailing Address - City:NEWCOMB
Mailing Address - State:TN
Mailing Address - Zip Code:37819-5072
Mailing Address - Country:US
Mailing Address - Phone:606-521-0142
Mailing Address - Fax:
Practice Address - Street 1:136 DAVIS LN
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3118
Practice Address - Country:US
Practice Address - Phone:423-562-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1018224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant