Provider Demographics
NPI:1316507650
Name:SANDIFER, TANYELLE (COTA/L)
Entity type:Individual
Prefix:
First Name:TANYELLE
Middle Name:
Last Name:SANDIFER
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 1:4312 BRIDLE RUN LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2299
Mailing Address - Country:US
Mailing Address - Phone:774-242-6702
Mailing Address - Fax:
Practice Address - Street 1:4312 BRIDLE RUN LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2299
Practice Address - Country:US
Practice Address - Phone:774-242-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant