Provider Demographics
NPI:1083815211
Name:YODER, SARAH L (BS,COTA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:L
Last Name:YODER
Suffix:
Gender:F
Credentials:BS,COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 E RED CEDAR LN
Mailing Address - Street 2:N201
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-9687
Mailing Address - Country:US
Mailing Address - Phone:208-571-5098
Mailing Address - Fax:
Practice Address - Street 1:100 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6126
Practice Address - Country:US
Practice Address - Phone:208-489-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID201224Z00000X
OH3253224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant