Provider Demographics
NPI:1144988643
Name:SYLVIA, JOLIE LYN (COTA)
Entity type:Individual
Prefix:
First Name:JOLIE
Middle Name:LYN
Last Name:SYLVIA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JOLIE
Other - Middle Name:LYN
Other - Last Name:BELTRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:217 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:EMMA
Mailing Address - State:MO
Mailing Address - Zip Code:65327
Mailing Address - Country:US
Mailing Address - Phone:518-866-1116
Mailing Address - Fax:
Practice Address - Street 1:217 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:EMMA
Practice Address - State:MO
Practice Address - Zip Code:65327
Practice Address - Country:US
Practice Address - Phone:518-866-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042407224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant