Provider Demographics
NPI:1194189175
Name:HARBUT, SARAH NICOLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:HARBUT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:NICOLE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:140 E WOODBURY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2841
Mailing Address - Country:US
Mailing Address - Phone:937-938-1523
Mailing Address - Fax:937-938-6877
Practice Address - Street 1:140 E WOODBURY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2841
Practice Address - Country:US
Practice Address - Phone:937-938-1523
Practice Address - Fax:937-938-6877
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA06356224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant