Provider Demographics
NPI:1184868341
Name:VANDERROEST, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:VANDERROEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 N ROSEBUD DR SE
Mailing Address - Street 2:5
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9401
Mailing Address - Country:US
Mailing Address - Phone:616-855-5650
Mailing Address - Fax:
Practice Address - Street 1:3890 N ROSEBUD DR SE
Practice Address - Street 2:5
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-9401
Practice Address - Country:US
Practice Address - Phone:616-855-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007070224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant