MEDICARE: MS. SARAH LEE CARLTON OTR

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	OT0000158	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT00001548	OTHER	WA	WASHINGTON STATE DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1831470186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH LEE CARLTON OTR

Provider Business Mailing Address
First Line	:	14834 39TH AVE NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-7813
Country	:	US
Telephone Number	:	206-297-1415
Fax Number	:

Provider Business Practice Location Address
First Line	:	14834 39TH AVE NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-7813
Country	:	US
Telephone Number	:	206-297-1415
Fax Number	:

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

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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