Provider Demographics
NPI:1144615477
Name:OTT, SARAH ANNETTE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNETTE
Last Name:OTT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 WASHINGTON ST
Mailing Address - Street 2:APT. 4R
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5070
Mailing Address - Country:US
Mailing Address - Phone:630-699-4048
Mailing Address - Fax:
Practice Address - Street 1:156 WILLIAM STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038
Practice Address - Country:US
Practice Address - Phone:212-281-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20961235Z00000X
NY025203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist