Healthcare Provider Details

I. General information

NPI: 1598918542
Provider Name (Legal Business Name): SARAH HALFACRE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 LOUISE UNDERWOOD WAY
LOUISVILLE KY
40216-3987
US

IV. Provider business mailing address

4501 LOUISE UNDERWOOD WAY
LOUISVILLE KY
40216-3987
US

V. Phone/Fax

Practice location:
  • Phone: 502-368-2348
  • Fax:
Mailing address:
  • Phone: 502-368-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKY-R4070
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberKY-R4070
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number131967
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: