Provider Demographics
NPI:1629715966
Name:PRESTON, SHEILA MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4563 N SO HI BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86413-9666
Mailing Address - Country:US
Mailing Address - Phone:714-831-7090
Mailing Address - Fax:
Practice Address - Street 1:3855 SUNSHINE DR
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3427
Practice Address - Country:US
Practice Address - Phone:928-716-9330
Practice Address - Fax:928-496-2083
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-047069224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant