Provider Demographics
NPI:1336554088
Name:SANBORN, MEGHAN (OT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:SANBORN
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 1:1013 E COEUR DALENE AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4121
Mailing Address - Country:US
Mailing Address - Phone:208-755-8511
Mailing Address - Fax:
Practice Address - Street 1:1013 E COEUR DALENE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4121
Practice Address - Country:US
Practice Address - Phone:208-755-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATL60478674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist