Provider Demographics
NPI:1467934646
Name:SANDERS, WYKEIA MONIQUE (COTA)
Entity Type:Individual
Prefix:
First Name:WYKEIA
Middle Name:MONIQUE
Last Name:SANDERS
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 1:586 PENAL FARM RD
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:LA
Mailing Address - Zip Code:71073-3053
Mailing Address - Country:US
Mailing Address - Phone:318-834-6222
Mailing Address - Fax:
Practice Address - Street 1:306 E NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5794
Practice Address - Country:US
Practice Address - Phone:505-863-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214349224Z00000X
NM4279224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant