Individual
CONNISHA SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
8309, BRIDGEWAY CIR APT 3A, FORT WAYNE, IN 46816
(260) 715-2904
Mailing address
1955 VERNON ST, WABASH, IN 46992-4026
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002009A
IN
Other
Enumeration date
06/16/2011
Last updated
10/01/2014
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