Healthcare Provider Details

I. General information

NPI: 1073261970
Provider Name (Legal Business Name): SARAH DAGHESTANI OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WOODPECKER WAY
MARLBORO NJ
07746-2517
US

IV. Provider business mailing address

35 WOODPECKER WAY
MARLBORO NJ
07746-2517
US

V. Phone/Fax

Practice location:
  • Phone: 718-208-6814
  • Fax:
Mailing address:
  • Phone: 718-208-6814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01049100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: