Provider Demographics
NPI:1457864696
Name:CLANCY, SARAH ROSE (OTR)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:CLANCY
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 1:6060 VILLAGE BEND DR APT 1816
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-3724
Mailing Address - Country:US
Mailing Address - Phone:281-825-2345
Mailing Address - Fax:
Practice Address - Street 1:550 E ANN ARBOR AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-6718
Practice Address - Country:US
Practice Address - Phone:214-376-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118596225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist