Healthcare Provider Details

I. General information

NPI: 1326472036
Provider Name (Legal Business Name): SARAH A. PROWAK MS, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SARAH A. PORCELAN

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 18TH ST SUITE 150A
DENVER CO
80211-3994
US

IV. Provider business mailing address

2680 18TH ST SUITE 150A
DENVER CO
80211-3994
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-0852
  • Fax:
Mailing address:
  • Phone: 303-433-0852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0003726
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: