Provider Demographics
NPI:1710301106
Name:SHIVLEY, SARAH J (OT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:SHIVLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:BARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1265 SGT JON STILES DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2266
Mailing Address - Country:US
Mailing Address - Phone:303-274-7332
Mailing Address - Fax:720-497-6733
Practice Address - Street 1:1550 S POTOMAC ST STE 180
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5448
Practice Address - Country:US
Practice Address - Phone:303-744-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010448225X00000X
CO5930225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400124630Medicare PIN