Provider Demographics
NPI:1326291980
Name:DEROUIN, SARAH CROUCH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:CROUCH
Last Name:DEROUIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15800 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:SACKETS HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:13685-3110
Mailing Address - Country:US
Mailing Address - Phone:315-778-2812
Mailing Address - Fax:315-639-3337
Practice Address - Street 1:15800 MILITARY RD
Practice Address - Street 2:
Practice Address - City:SACKETS HARBOR
Practice Address - State:NY
Practice Address - Zip Code:13685-3110
Practice Address - Country:US
Practice Address - Phone:315-778-2812
Practice Address - Fax:315-639-3337
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008177-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics