Healthcare Provider Details

I. General information

NPI: 1295399426
Provider Name (Legal Business Name): SARAH ELIZABETH HALSTEAD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 7TH ST W
SAINT PAUL MN
55116-2813
US

IV. Provider business mailing address

2989 S WILLOW ST
DENVER CO
80231-4230
US

V. Phone/Fax

Practice location:
  • Phone: 651-698-0793
  • Fax:
Mailing address:
  • Phone: 651-698-0793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number105901
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: