Provider Demographics
NPI:1477678753
Name:RUTLEDGE, SARA L (OTR)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:RUTLEDGE
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 1:100 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5823
Mailing Address - Country:US
Mailing Address - Phone:516-799-2900
Mailing Address - Fax:516-799-2928
Practice Address - Street 1:100 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5823
Practice Address - Country:US
Practice Address - Phone:516-799-2900
Practice Address - Fax:516-799-2928
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003247225XP0200X
NY015316225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015316OtherNY STATE OCCUPATIONAL THERAPY LICENSE
NY015316OtherNY STATE OCCUPATIONAL THERAPY LICENSE