MEDICARE: SARAH MARGARET PREVOST OTR/L

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	225XP0019X	Physical Rehabilitation Occupational Therapist	5201013366	MI

General Provider Information

NPI Number	:	1720775810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MARGARET PREVOST OTR/L

Provider Business Mailing Address
First Line	:	7200 KING RD
Second Line	:
City	:	SPRING ARBOR
State	:	MI
Zip	:	49283-9790
Country	:	US
Telephone Number	:	517-358-9408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 MICHIGAN AVE E
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-6113
Country	:	US
Telephone Number	:	269-962-5458
Fax Number	:

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

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	04/19/2023

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