Provider Demographics
NPI:1497952881
Name:GARRISON, SANDRA A (MSOTR-L)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:A
Last Name:GARRISON
Suffix:
Gender:F
Credentials:MSOTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 ELMHURST WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-0203
Mailing Address - Country:US
Mailing Address - Phone:270-746-0727
Mailing Address - Fax:
Practice Address - Street 1:1420 ELMHURST WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-0203
Practice Address - Country:US
Practice Address - Phone:270-746-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R1048225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist