Provider Demographics
NPI:1093882607
Name:OTTEN, SARA HELENA (DPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HELENA
Last Name:OTTEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:HELENA
Other - Last Name:GRAFIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-0578
Mailing Address - Country:US
Mailing Address - Phone:503-489-1174
Mailing Address - Fax:
Practice Address - Street 1:450 NW GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1531
Practice Address - Country:US
Practice Address - Phone:541-923-0410
Practice Address - Fax:541-923-7393
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241820Medicaid
OR241820Medicaid