Provider Demographics
NPI:1497952832
Name:HAYDON, SABRA ANN (COTA)
Entity Type:Individual
Prefix:MISS
First Name:SABRA
Middle Name:ANN
Last Name:HAYDON
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 1:1 PIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2231
Mailing Address - Country:US
Mailing Address - Phone:502-472-7533
Mailing Address - Fax:
Practice Address - Street 1:545 W MOONGLO RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7710
Practice Address - Country:US
Practice Address - Phone:812-752-3499
Practice Address - Fax:812-752-7632
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99027352A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant