Provider Demographics
NPI:1932332335
Name:RAMASAMY, SORNA
Entity Type:Individual
Prefix:
First Name:SORNA
Middle Name:
Last Name:RAMASAMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 SOUTHWEST BLVD
Mailing Address - Street 2:APT Q
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5022
Mailing Address - Country:US
Mailing Address - Phone:215-859-8184
Mailing Address - Fax:
Practice Address - Street 1:919 SOUTHWEST BLVD
Practice Address - Street 2:APT Q
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5022
Practice Address - Country:US
Practice Address - Phone:215-859-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13601225X00000X
PAOC011128225X00000X
TX113183225X00000X
MO2012001163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist