Healthcare Provider Details

I. General information

NPI: 1285225649
Provider Name (Legal Business Name): SARAH STEVENSON MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 EGLIN PKWY SE
FORT WALTON BEACH FL
32548-5899
US

IV. Provider business mailing address

208 S PINEHURST LN
YORKTOWN IN
47396-9339
US

V. Phone/Fax

Practice location:
  • Phone: 850-200-4348
  • Fax: 850-200-4350
Mailing address:
  • Phone: 260-446-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number21490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: