Provider Demographics
NPI:1104307636
Name:HENDERSON, SANDRA CLAUDETTE (COTA)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:CLAUDETTE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 WISTERIA ST
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-6518
Mailing Address - Country:US
Mailing Address - Phone:580-221-7680
Mailing Address - Fax:
Practice Address - Street 1:1900 ONEAL ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-3604
Practice Address - Country:US
Practice Address - Phone:940-665-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211073224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant