Provider Demographics
NPI:1013199884
Name:STERN, SARA HOLLY (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:HOLLY
Last Name:STERN
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 1:1117 S EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2105
Mailing Address - Country:US
Mailing Address - Phone:708-848-8893
Mailing Address - Fax:708-848-7793
Practice Address - Street 1:1117 S EAST AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2105
Practice Address - Country:US
Practice Address - Phone:708-848-8893
Practice Address - Fax:708-848-7793
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL918790Medicare PIN