Healthcare Provider Details

I. General information

NPI: 1548170673
Provider Name (Legal Business Name): SARAH ELIZABETH PHAROAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 COMMERCE LN
CANTON NY
13617-9672
US

IV. Provider business mailing address

1720 S MAIN ST
SAINT REGIS FALLS NY
12980-2605
US

V. Phone/Fax

Practice location:
  • Phone: 315-379-9531
  • Fax:
Mailing address:
  • Phone: 315-321-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number031207
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: