Provider Demographics
NPI:1629374483
Name:ACOSTA, SANDRA (OTR)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 BIRCHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3706
Mailing Address - Country:US
Mailing Address - Phone:951-256-0115
Mailing Address - Fax:
Practice Address - Street 1:4710 BIRCHWOOD CIR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-3706
Practice Address - Country:US
Practice Address - Phone:951-256-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11331225X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist