MEDICARE: SARAH MARTIN MOT, 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	31005776A	IN

General Provider Information

NPI Number	:	1861899155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MARTIN MOT, OTR

Provider Business Mailing Address
First Line	:	700 E. FIRMIN STREET
Second Line	:	SUITE 209
City	:	KOKOMO
State	:	IN
Zip	:	46902-2375
Country	:	US
Telephone Number	:	765-454-9748
Fax Number	:	765-450-6664

Provider Business Practice Location Address
First Line	:	1300 AIRPORT NORTH OFFICE PARK
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6716
Country	:	US
Telephone Number	:	260-471-9263
Fax Number	:	260-471-9264

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

Provider Enumeration Date	:	12/02/2014
Last Update Date	:	12/02/2014

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