Provider Demographics
NPI:1538495338
Name:DIBERNARDO, SARA ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELIZABETH
Last Name:DIBERNARDO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:20 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5520
Mailing Address - Country:US
Mailing Address - Phone:914-456-9194
Mailing Address - Fax:
Practice Address - Street 1:15 CROFT RD
Practice Address - Street 2:SPACKENKILL UNION FREE SCHOOL DISTRICT- OT
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-4917
Practice Address - Country:US
Practice Address - Phone:845-463-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015698-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist