Basic Information
| Provider Information | |||||||||
| NPI: | 1821506130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRATT | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | OTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970452241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039567505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036578903 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2018 | ||||||||
| LastUpdateDate: | 11/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 367849 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 367849 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 5201009696 | 01 | MI | STATE OF MICHIGAN OCCUPATIONAL THERAPIST LICENSE | OTHER | 367849 | 01 | THE NATIONAL BOARD OF CERTIFICATION IN OCCUPATIONAL THERAPY ( NBCOT) | OTHER | 367849 | 01 | OR | OREGON OCCUPATIONAL THERAPY LICENSING BOARD | OTHER |