Provider Demographics
NPI:1407338676
Name:SMIGEL, SARAH (COTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SMIGEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1366
Mailing Address - Country:US
Mailing Address - Phone:518-719-3619
Mailing Address - Fax:518-719-3779
Practice Address - Street 1:411 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1366
Practice Address - Country:US
Practice Address - Phone:518-719-3619
Practice Address - Fax:518-719-3779
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009878224Z00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473230Medicaid