Basic Information
| Provider Information | |||||||||
| NPI: | 1104304617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCARTY | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MAE | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1660 | ||||||||
| Address2: | |||||||||
| City: | AZTEC | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874104660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053218648 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 SAGUARO TRL | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874019632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055986000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2018 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 3962 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.