Healthcare Provider Details

I. General information

NPI: 1134227242
Provider Name (Legal Business Name): SARAH B VORE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W HAYCRAFT AVE STE D1
COEUR D ALENE ID
83815-8104
US

IV. Provider business mailing address

7130 W CHRISTINE ST
RATHDRUM ID
83858-5144
US

V. Phone/Fax

Practice location:
  • Phone: 208-664-2468
  • Fax:
Mailing address:
  • Phone: 512-695-7819
  • Fax: 512-306-7380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number109634
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number109634
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number9671934
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: