Provider Demographics
NPI:1215187844
Name:JOHNSON, SARAH M (OTR/L, CLT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 S COOK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4923
Mailing Address - Country:US
Mailing Address - Phone:563-650-6474
Mailing Address - Fax:
Practice Address - Street 1:1060 S COOK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4923
Practice Address - Country:US
Practice Address - Phone:563-650-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0003347225X00000X
IA01657225X00000X
IL056.007808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist