Provider Demographics
NPI:1952639106
Name:SANCHEZ, ANGEL R (COTA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:R
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 QUEENS BLVD
Mailing Address - Street 2:APT.3F
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7758
Mailing Address - Country:US
Mailing Address - Phone:718-569-2435
Mailing Address - Fax:
Practice Address - Street 1:5940 QUEENS BLVD
Practice Address - Street 2:APT.3F
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7758
Practice Address - Country:US
Practice Address - Phone:718-569-2435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002926224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant