Provider Demographics
NPI:1134797855
Name:KOTOMSKI, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KOTOMSKI
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 1:5605 MAUNA LOA BLVD UNIT 309
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8955
Mailing Address - Country:US
Mailing Address - Phone:724-355-9917
Mailing Address - Fax:
Practice Address - Street 1:5605 MAUNA LOA BLVD UNIT 309
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8955
Practice Address - Country:US
Practice Address - Phone:724-355-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA96776225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist