MEDICARE: SARAH M KING OT

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
1	225X00000X	Occupational Therapist	007867	OH

General Provider Information

NPI Number	:	1619243177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH M KING OT

Provider Business Mailing Address
First Line	:	1356 N ATHENA CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-3818
Country	:	US
Telephone Number	:	937-371-6464
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 W SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-4716
Country	:	US
Telephone Number	:	937-371-6464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/22/2019

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