Provider Demographics
NPI:1548761240
Name:ANDERSON, SARA RUTH (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:RUTH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8547 CORY DR
Mailing Address - Street 2:
Mailing Address - City:DELTON
Mailing Address - State:MI
Mailing Address - Zip Code:49046-8757
Mailing Address - Country:US
Mailing Address - Phone:269-908-3678
Mailing Address - Fax:
Practice Address - Street 1:530 BEECH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1016
Practice Address - Country:US
Practice Address - Phone:517-543-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-10-03
Deactivation Date:2018-02-27
Deactivation Code:
Reactivation Date:2018-10-03
Provider Licenses
StateLicense IDTaxonomies
MI5201009319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist