MEDICARE: SARAH RAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0119007241	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0119007241	OTHER	VA	OT LICENSE

General Provider Information

NPI Number	:	1609411891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH RAY

Provider Business Mailing Address
First Line	:	4650 WASHINGTON BLVD APT 627
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-5743
Country	:	US
Telephone Number	:	908-448-9272
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 WASHINGTON BLVD APT 627
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-5743
Country	:	US
Telephone Number	:	908-448-9272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	11/12/2019

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Directions to “ SARAH RAY ” Practice Location

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