Provider Demographics
NPI:1548470818
Name:ENGBROTEN, SANDRA F (COTA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:F
Last Name:ENGBROTEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:F
Other - Last Name:SHILT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:8533 NE 91ST TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-8625
Mailing Address - Country:US
Mailing Address - Phone:816-407-9310
Mailing Address - Fax:
Practice Address - Street 1:111 NW MOCK AVE
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2503
Practice Address - Country:US
Practice Address - Phone:816-407-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003127224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant