Provider Demographics
NPI:1558645408
Name:PHANKOT, SARAH KATIE ANNA (MS OTR)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KATIE ANNA
Last Name:PHANKOT
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2637
Mailing Address - Country:US
Mailing Address - Phone:970-222-7805
Mailing Address - Fax:
Practice Address - Street 1:813 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2637
Practice Address - Country:US
Practice Address - Phone:970-222-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2975225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics