Provider Demographics
NPI:1851062061
Name:BLUMENTHAL, SANDRA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BLUMENTHAL
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 1:3111 E 4TH ST APT 149
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4528
Mailing Address - Country:US
Mailing Address - Phone:718-613-9337
Mailing Address - Fax:
Practice Address - Street 1:2900 E MILBER ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-2097
Practice Address - Country:US
Practice Address - Phone:520-294-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-008626225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist