Provider Demographics
NPI:1497150247
Name:SUNBREAK THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:SUNBREAK THERAPY SERVICES, INC
Other - Org Name:SPEECH WITH SARAH - LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-266-1030
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013
Mailing Address - Country:US
Mailing Address - Phone:503-266-1030
Mailing Address - Fax:971-244-9044
Practice Address - Street 1:366 N. HOLLY ST.
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013
Practice Address - Country:US
Practice Address - Phone:503-266-1030
Practice Address - Fax:971-244-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X, 235Z00000X
OR013412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500658826Medicaid
OR1518369123OtherNPI
OR1740832732OtherNPI
OR1962540153OtherNPI