Provider Demographics
NPI:1629681713
Name:BACH, SARAH MAREN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MAREN
Last Name:BACH
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MAREN
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4547 ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6447
Mailing Address - Country:US
Mailing Address - Phone:619-504-7455
Mailing Address - Fax:
Practice Address - Street 1:9620 CHESAPEAKE DR STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1324
Practice Address - Country:US
Practice Address - Phone:858-859-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18878225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics