Healthcare Provider Details

I. General information

NPI: 1992875439
Provider Name (Legal Business Name): SARAH A PETERMAN OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH A JACKSON OTRL

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N ANKENY BLVD
ANKENY IA
50023-1750
US

IV. Provider business mailing address

450 LAUREL ST STE A
DES MOINES IA
50314-3045
US

V. Phone/Fax

Practice location:
  • Phone: 515-965-5311
  • Fax: 515-963-5301
Mailing address:
  • Phone: 515-699-8378
  • Fax: 515-248-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number01321
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: