Healthcare Provider Details

I. General information

NPI: 1063051399
Provider Name (Legal Business Name): SARAH BETH RADER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100968 S 4650 RD
SALLISAW OK
74955-2672
US

IV. Provider business mailing address

1628 HIGHWAY 288
CHARLESTON AR
72933-9557
US

V. Phone/Fax

Practice location:
  • Phone: 479-650-1575
  • Fax:
Mailing address:
  • Phone: 479-650-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1616
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOTR1616
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOTR1616
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1706
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: