Provider Demographics
NPI:1609006014
Name:JORDAN, SARAH BETH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BETH
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8204 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-9509
Mailing Address - Country:US
Mailing Address - Phone:307-634-1741
Mailing Address - Fax:
Practice Address - Street 1:4024 LARAMIE ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2064
Practice Address - Country:US
Practice Address - Phone:307-634-5384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY471225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist