Provider Demographics
NPI:1417391624
Name:MASTERS, SYLVIA (COTA)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:MASTERS
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 1:1203 E CENTRAL AVE
Mailing Address - Street 2:APT. 406
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4300
Mailing Address - Country:US
Mailing Address - Phone:909-200-8438
Mailing Address - Fax:
Practice Address - Street 1:1203 E CENTRAL AVE
Practice Address - Street 2:APT. 406
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4300
Practice Address - Country:US
Practice Address - Phone:909-200-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 722224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant