Provider Demographics
NPI:1336562297
Name:MONTOYA, SAHRA AMANDA (COTA)
Entity Type:Individual
Prefix:MISS
First Name:SAHRA
Middle Name:AMANDA
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:SAHRA
Other - Middle Name:AMANDA
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:2255 W ORANGE GROVE RD APT 6208
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3155
Mailing Address - Country:US
Mailing Address - Phone:575-956-8110
Mailing Address - Fax:
Practice Address - Street 1:2255 W ORANGE GROVE RD APT 6208
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3155
Practice Address - Country:US
Practice Address - Phone:575-956-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5585224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant