Provider Demographics
NPI:1477205862
Name:LEWANDOWSKI, SARA (OT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13428 MAXELLA AVE # 115
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5620
Mailing Address - Country:US
Mailing Address - Phone:310-907-9215
Mailing Address - Fax:310-953-3281
Practice Address - Street 1:1724 OBISPO AVE APT 4
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-1736
Practice Address - Country:US
Practice Address - Phone:310-907-9215
Practice Address - Fax:310-953-3281
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17336225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty