Provider Demographics
NPI:1285225649
Name:STEVENSON, SARAH (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S PINEHURST LN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-9339
Mailing Address - Country:US
Mailing Address - Phone:260-446-4995
Mailing Address - Fax:
Practice Address - Street 1:220 EGLIN PKWY SE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5899
Practice Address - Country:US
Practice Address - Phone:850-200-4348
Practice Address - Fax:850-200-4350
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21490225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty