Provider Demographics
NPI:1619221843
Name:DEPEW, SARA COLEMAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:COLEMAN
Last Name:DEPEW
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 1:705 E POPLAR AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-1828
Mailing Address - Country:US
Mailing Address - Phone:731-453-5511
Mailing Address - Fax:731-646-0285
Practice Address - Street 1:705 E POPLAR AVE
Practice Address - Street 2:STE 101
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-1828
Practice Address - Country:US
Practice Address - Phone:731-453-5511
Practice Address - Fax:731-646-0285
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist