Provider Demographics
NPI:1790064756
Name:SANTISTEBAN SOSA, TAIMI (OT)
Entity Type:Individual
Prefix:MRS
First Name:TAIMI
Middle Name:
Last Name:SANTISTEBAN SOSA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:TAIMI
Other - Middle Name:
Other - Last Name:BORGES ALEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:3342 CIRCLE BROOK DR APT H
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-7250
Mailing Address - Country:US
Mailing Address - Phone:786-219-5024
Mailing Address - Fax:
Practice Address - Street 1:3342 CIRCLE BROOK DR APT H
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-7250
Practice Address - Country:US
Practice Address - Phone:786-219-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 18289225XP0200X
VA0119009094225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics