Healthcare Provider Details

I. General information

NPI: 1013835172
Provider Name (Legal Business Name): SARAH KOHBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

400 LAKE ST
ITHACA NY
14850-2132
US

IV. Provider business mailing address

931 DRYDEN RD APT 2
ITHACA NY
14850-2914
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-2264
  • Fax:
Mailing address:
  • Phone: 315-651-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number030822
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: