Individual
SONIA BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3004 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4109
(308) 398-5170
(308) 398-5175
Mailing address
PO BOX 5285, GRAND ISLAND, NE 68802-5285
(308) 398-5170
(308) 398-5175
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
995
NE
Other
Enumeration date
06/11/2020
Last updated
06/11/2020
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