Provider Demographics
NPI:1114698370
Name:ADKISSON, SARAH L (OT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:ADKISSON
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 1:9430 PALOMINO RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-5820
Mailing Address - Country:US
Mailing Address - Phone:619-654-7353
Mailing Address - Fax:
Practice Address - Street 1:9903 BUSINESSPARK AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1120
Practice Address - Country:US
Practice Address - Phone:619-654-7353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1502225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation