Healthcare Provider Details

I. General information

NPI: 1720412067
Provider Name (Legal Business Name): SARA OSTERHOUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 DUNN AVE
DAYTONA BEACH FL
32114-2405
US

IV. Provider business mailing address

4 PALMETTO DUNES CT
ORMOND BEACH FL
32174-8782
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-4568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 13074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: