Provider Demographics
NPI:1922773787
Name:AYALA, SANDEE KAY (COTA)
Entity Type:Individual
Prefix:
First Name:SANDEE
Middle Name:KAY
Last Name:AYALA
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 1:8594 E 116TH ST APT 116
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1570
Mailing Address - Country:US
Mailing Address - Phone:219-384-7483
Mailing Address - Fax:
Practice Address - Street 1:GREEN HOUSE COTTAGES OF CARMEL
Practice Address - Street 2:616 GREEN HOUSE WAY
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-401-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002924A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant