Provider Demographics
NPI:1790081339
Name:SANTOS, SANDRA ISABEL (OTR/L, CLT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ISABEL
Last Name:SANTOS
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 HAWK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1822
Mailing Address - Country:US
Mailing Address - Phone:915-252-9265
Mailing Address - Fax:
Practice Address - Street 1:4019 HAWK ST APT 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1822
Practice Address - Country:US
Practice Address - Phone:915-252-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-30
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
015187225XP0019X
NY015187225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics