Provider Demographics
NPI:1578111811
Name:SMIDT, SARA KATHERINE (OTR/L, MOT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KATHERINE
Last Name:SMIDT
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13220 BIRCH DR
Mailing Address - Street 2:STE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5434
Mailing Address - Country:US
Mailing Address - Phone:402-932-2888
Mailing Address - Fax:402-932-2899
Practice Address - Street 1:13220 BIRCH DR STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5434
Practice Address - Country:US
Practice Address - Phone:402-932-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2316225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist