Healthcare Provider Details

I. General information

NPI: 1811612930
Provider Name (Legal Business Name): SARAH HEFFERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 PORTLAND ST
SOUTH BERWICK ME
03908-1203
US

IV. Provider business mailing address

10 WOOD AVE
ELIOT ME
03903-2227
US

V. Phone/Fax

Practice location:
  • Phone: 207-351-2018
  • Fax:
Mailing address:
  • Phone: 207-459-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3360
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT4353
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: