Provider Demographics
NPI:1003304809
Name:HARRISON, SARA AILEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:AILEEN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 HUGHES WAY # 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1870
Mailing Address - Country:US
Mailing Address - Phone:323-397-8729
Mailing Address - Fax:
Practice Address - Street 1:1500 HUGHES WAY # 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810-1870
Practice Address - Country:US
Practice Address - Phone:323-397-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20602225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist