Healthcare Provider Details

I. General information

NPI: 1568693448
Provider Name (Legal Business Name): SALLY M WEBSTER MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 INDEPENDENCE AVE SE
WASHINGTON DC
20003-1255
US

IV. Provider business mailing address

658 INDEPENDENCE AVE SE
WASHINGTON DC
20003-1255
US

V. Phone/Fax

Practice location:
  • Phone: 251-406-1274
  • Fax: 251-406-1274
Mailing address:
  • Phone: 251-406-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2648
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010000829
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: