Provider Demographics
NPI:1013563683
Name:KELLY, SARA (OT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 W NORTHERN LIGHTS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3652
Mailing Address - Country:US
Mailing Address - Phone:907-212-2090
Mailing Address - Fax:907-212-2570
Practice Address - Street 1:PO BOX 4105
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97208-4105
Practice Address - Country:US
Practice Address - Phone:866-907-1068
Practice Address - Fax:425-917-9141
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-10
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1925225X00000X
AK206012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty