Healthcare Provider Details

I. General information

NPI: 1033785886
Provider Name (Legal Business Name): SARAH WARDELL MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 FARM RD
WATERFORD MI
48327-2420
US

IV. Provider business mailing address

7426 S VILLAGE DR
CLARKSTON MI
48346-1999
US

V. Phone/Fax

Practice location:
  • Phone: 248-674-0805
  • Fax:
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201011312
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: