Provider Demographics
NPI:1780072405
Name:JOHANSSON, SARAH (MOTR/L)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JOHANSSON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:301 NORTH 8TH STREET
Mailing Address - City:SINCLAIR
Mailing Address - State:WY
Mailing Address - Zip Code:82334-0346
Mailing Address - Country:US
Mailing Address - Phone:307-324-7257
Mailing Address - Fax:
Practice Address - Street 1:301 NORTH 8TH STREET
Practice Address - Street 2:
Practice Address - City:SINCLAIR
Practice Address - State:WY
Practice Address - Zip Code:82334-0346
Practice Address - Country:US
Practice Address - Phone:307-324-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-467225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist