Provider Demographics
NPI:1366637712
Name:HENNESSY, SARA KATHERINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KATHERINE
Last Name:HENNESSY
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 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-288-0122
Practice Address - Street 1:1005 N FREDERICK AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-1018
Practice Address - Country:US
Practice Address - Phone:319-283-2002
Practice Address - Fax:319-283-2015
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01030225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1821461344Medicaid
IA64080680OtherAMERIHEALTH CARITAS
IA1821461344OtherBCBS
IA35202809OtherAMERIGROUP
IAIB1211007Medicare PIN