Provider Demographics
NPI:1922206473
Name:DEITERING, SARA DENISE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:DENISE
Last Name:DEITERING
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 28TH ST
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1102
Mailing Address - Country:US
Mailing Address - Phone:800-334-1919
Mailing Address - Fax:
Practice Address - Street 1:1646 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-1760
Practice Address - Country:US
Practice Address - Phone:712-362-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00434224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant