Provider Demographics
NPI:1770143877
Name:SOVA, JOSIE (COTA/L)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:SOVA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 SW RIMROCK WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8657
Mailing Address - Country:US
Mailing Address - Phone:504-401-2167
Mailing Address - Fax:
Practice Address - Street 1:900 NE 27TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9548
Practice Address - Country:US
Practice Address - Phone:504-401-2167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4736224Z00000X
OR326613224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant