Provider Demographics
NPI:1487632352
Name:HOCKEY, SARAH BETH (OTR)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:HOCKEY
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 1:812 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:S LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6413
Mailing Address - Country:US
Mailing Address - Phone:530-542-2662
Mailing Address - Fax:530-542-2661
Practice Address - Street 1:812 EMERALD BAY RD
Practice Address - Street 2:
Practice Address - City:S LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6413
Practice Address - Country:US
Practice Address - Phone:530-542-2662
Practice Address - Fax:530-542-2661
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5588225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4744930001Medicare NSC