Provider Demographics
NPI:1245551266
Name:LONERGAN, SANDRA K (OT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:LONERGAN
Suffix:
Gender:F
Credentials:OT
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 3585
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-3585
Mailing Address - Country:US
Mailing Address - Phone:573-823-1859
Mailing Address - Fax:
Practice Address - Street 1:5816 HIGHWAY 54
Practice Address - Street 2:SUITE 103A
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3046
Practice Address - Country:US
Practice Address - Phone:573-348-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010017544225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics