Provider Demographics
NPI:1982438321
Name:SANGSTER, NIKKI K (COTA/L)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:K
Last Name:SANGSTER
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 1:6346 TIPPETTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092-6518
Mailing Address - Country:US
Mailing Address - Phone:229-947-0481
Mailing Address - Fax:
Practice Address - Street 1:6346 TIPPETTVILLE RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:GA
Practice Address - Zip Code:31092-6518
Practice Address - Country:US
Practice Address - Phone:229-947-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA000734224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant