Healthcare Provider Details

I. General information

NPI: 1104749902
Provider Name (Legal Business Name): SARAH TANNER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 WILLMAR AVE SW
WILLMAR MN
56201-2882
US

IV. Provider business mailing address

24237 COUNTY ROAD 5 NW
NEW LONDON MN
56273-9656
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number100090
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: