Provider Demographics
NPI:1467234435
Name:KETTERMAN, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KETTERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 TERRACE ST APT 102
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-5239
Mailing Address - Country:US
Mailing Address - Phone:717-779-6679
Mailing Address - Fax:
Practice Address - Street 1:920 GERMANTOWN PIKE STE 103
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-7401
Practice Address - Country:US
Practice Address - Phone:484-370-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0C018560225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics