Provider Demographics
NPI:1891086898
Name:FERGUSON, SARA JAN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JAN
Last Name:FERGUSON
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:PO BOX 842
Mailing Address - Street 2:29718 COUNTY ROAD #16.0
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-0842
Mailing Address - Country:US
Mailing Address - Phone:719-859-0814
Mailing Address - Fax:
Practice Address - Street 1:409 BENEDICTA AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2004
Practice Address - Country:US
Practice Address - Phone:719-846-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002176225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA307868OtherNBCOT (NATIONAL BOARD OF CERTIFIED OCCUPATIONAL THERAPISTS)