Provider Demographics
NPI:1376240176
Name:MEDINA, SARAH (COTA/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1963 DORION ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1212
Mailing Address - Country:US
Mailing Address - Phone:502-598-6139
Mailing Address - Fax:
Practice Address - Street 1:402 13TH AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1267
Practice Address - Country:US
Practice Address - Phone:218-834-8374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist