Healthcare Provider Details

I. General information

NPI: 1053885574
Provider Name (Legal Business Name): SARAH CATHERINE NELSON MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 7TH AVE
HUNTINGTON WV
25701-2117
US

IV. Provider business mailing address

390 25TH AVE NW
HICKORY NC
28601-1248
US

V. Phone/Fax

Practice location:
  • Phone: 304-523-1164
  • Fax: 304-522-2474
Mailing address:
  • Phone: 828-781-7467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12711
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2010
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number106749
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: