Healthcare Provider Details

I. General information

NPI: 1164088092
Provider Name (Legal Business Name): SARAH LOUISE WIGMORE MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/18/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 RUGBY AVE
BETHESDA MD
20814-3035
US

IV. Provider business mailing address

4833 RUGBY AVE
BETHESDA MD
20814-3035
US

V. Phone/Fax

Practice location:
  • Phone: 301-523-0902
  • Fax:
Mailing address:
  • Phone: 301-523-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number09339
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: