Individual
SUNOMA CODISPOTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
19235 15TH AVE NW, SHORELINE, WA 98177-2725
(206) 546-2666
Mailing address
25117 SW PARKWAY AVE, STE D, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OC60539249
WA
Other
Enumeration date
04/06/2015
Last updated
04/06/2015
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