Provider Demographics
NPI:1043343734
Name:MUGAVERO, SARAH (OT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MUGAVERO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 BLUEWATER RD NW
Mailing Address - Street 2:JIMMY CARTER MS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-2024
Mailing Address - Country:US
Mailing Address - Phone:505-833-7540
Mailing Address - Fax:
Practice Address - Street 1:8901 BLUEWATER RD NW
Practice Address - Street 2:JIMMY CARTER MS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-2024
Practice Address - Country:US
Practice Address - Phone:505-833-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52371352Medicaid