Provider Demographics
NPI:1164088092
Name:WIGMORE, SARAH LOUISE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LOUISE
Last Name:WIGMORE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 RUGBY AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3035
Mailing Address - Country:US
Mailing Address - Phone:301-523-0902
Mailing Address - Fax:
Practice Address - Street 1:4833 RUGBY AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3035
Practice Address - Country:US
Practice Address - Phone:301-523-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09339225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics