Provider Demographics
NPI:1699019844
Name:OTTEN, SARA J (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:OTTEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1357 LOGAN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9115
Mailing Address - Country:US
Mailing Address - Phone:775-450-5834
Mailing Address - Fax:
Practice Address - Street 1:402 2ND AVE
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:IA
Practice Address - Zip Code:52216-9754
Practice Address - Country:US
Practice Address - Phone:563-452-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03549OtherPHYSICAL THERAPY LISENCE