Provider Demographics
NPI:1477122497
Name:RUSSELL, SARAH HOPE (M S OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:HOPE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:M S OTR/L
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:HOPE
Other - Last Name:ROETTGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M S OTR/L
Mailing Address - Street 1:1640 ASHLEY HALL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1640 ASHLEY HALL RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3824
Practice Address - Country:US
Practice Address - Phone:843-277-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist