Healthcare Provider Details

I. General information

NPI: 1306566898
Provider Name (Legal Business Name): SARAH M FRIESTH OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8527 UNIVERSITY BLVD STE 9
CLIVE IA
50325-1069
US

IV. Provider business mailing address

8527 UNIVERSITY BLVD STE 9
CLIVE IA
50325-1069
US

V. Phone/Fax

Practice location:
  • Phone: 515-782-1436
  • Fax:
Mailing address:
  • Phone: 515-782-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number121384
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: