Provider Demographics
NPI:1073261970
Name:DAGHESTANI, SARAH (OTR)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DAGHESTANI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WOODPECKER WAY
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2517
Mailing Address - Country:US
Mailing Address - Phone:718-208-6814
Mailing Address - Fax:
Practice Address - Street 1:35 WOODPECKER WAY
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2517
Practice Address - Country:US
Practice Address - Phone:718-208-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01049100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist