Provider Demographics
NPI:1578694527
Name:SORUM, SANDI
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:
Last Name:SORUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 E 54TH ST N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-0681
Mailing Address - Country:US
Mailing Address - Phone:605-328-9300
Mailing Address - Fax:605-328-9301
Practice Address - Street 1:900 E 54TH ST N
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0681
Practice Address - Country:US
Practice Address - Phone:605-328-9300
Practice Address - Fax:605-328-9301
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS101844Medicare PIN