Provider Demographics
NPI:1346383809
Name:RAFFERTY, SANDRA L (OTR)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 LAKEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-5357
Mailing Address - Country:US
Mailing Address - Phone:636-462-4612
Mailing Address - Fax:636-332-4941
Practice Address - Street 1:332 STABLE LN
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-5447
Practice Address - Country:US
Practice Address - Phone:636-332-4940
Practice Address - Fax:636-332-4941
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist