Provider Demographics
NPI:1851661086
Name:STIEN, SALLY RAE (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:RAE
Last Name:STIEN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 S KLEIN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-7230
Mailing Address - Country:US
Mailing Address - Phone:651-341-0399
Mailing Address - Fax:
Practice Address - Street 1:4004 S KLEIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-7230
Practice Address - Country:US
Practice Address - Phone:651-341-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3203225XP0019X
IA002174225XP0019X
SD0736225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation