Provider Demographics
NPI:1972638500
Name:DURHAM, SANDRA J (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:DURHAM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3905
Mailing Address - Country:US
Mailing Address - Phone:217-348-8266
Mailing Address - Fax:217-348-8266
Practice Address - Street 1:2310 4TH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3905
Practice Address - Country:US
Practice Address - Phone:217-348-8266
Practice Address - Fax:217-348-8266
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist