Provider Demographics
NPI:1982332003
Name:LINGO, SARA BROOKE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BROOKE
Last Name:LINGO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 GOLDENROD CIR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-9747
Mailing Address - Country:US
Mailing Address - Phone:302-422-3181
Mailing Address - Fax:
Practice Address - Street 1:17 GOLDENROD CIR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-9747
Practice Address - Country:US
Practice Address - Phone:302-422-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0012350225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist