Provider Demographics
NPI:1609096726
Name:MICHELLO, SONJA MARIANA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:MARIANA
Last Name:MICHELLO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:SONJA
Other - Middle Name:MARIANA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1734 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-5966
Mailing Address - Country:US
Mailing Address - Phone:615-497-8932
Mailing Address - Fax:
Practice Address - Street 1:1927 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-904-9111
Practice Address - Fax:615-867-5223
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOTA0000001343224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant