Healthcare Provider Details

I. General information

NPI: 1992915680
Provider Name (Legal Business Name): SANDRA KAY FOGARTY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BRIARWOOD CIRCLE BUILDING #4
ANN ARBOR MI
48108
US

IV. Provider business mailing address

5779 E SILO RIDGE DR
ANN ARBOR MI
48108-9574
US

V. Phone/Fax

Practice location:
  • Phone: 734-998-7911
  • Fax: 734-998-9429
Mailing address:
  • Phone: 734-769-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number5201000235
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: