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NPI Code Detail

MEDICARE: SARA ELIZABETH FOUTS OTR-L

MEDICARE: SARA ELIZABETH FOUTS OTR-L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist102604MN
2225X00000XOccupational Therapist3748-026WI

General Provider Information

NPI Number : 1609098474
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA ELIZABETH FOUTS OTR-L
Provider Business Mailing Address
First Line : 1106 E 4TH ST
Second Line :
City : SUPERIOR
State : WI
Zip : 54880-3348
Country : US
Telephone Number : 715-392-6047
Fax Number :
Provider Business Practice Location Address
First Line : 1601 SAINT LOUIS AVE
Second Line :
City : DULUTH
State : MN
Zip : 55802-2442
Country : US
Telephone Number : 218-740-3036
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 07/08/2007

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Directions to “ SARA ELIZABETH FOUTS OTR-L” Practice Location

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