Basic Information
Provider Information
NPI: 1710574470
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARIG
FirstName: SARAH
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2122 YORK RD STE 300
Address2:  
City: OAK BROOK
State: IL
PostalCode: 605231925
CountryCode: US
TelephoneNumber: 6305751980
FaxNumber:  
Practice Location
Address1: 1047 CENTURY DR
Address2:  
City: EDWARDSVILLE
State: IL
PostalCode: 620253772
CountryCode: US
TelephoneNumber: 6183073434
FaxNumber: 6183073435
Other Information
ProviderEnumerationDate: 12/29/2020
LastUpdateDate: 10/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X2020033521MOY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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