Provider Demographics
NPI:1053890574
Name:PRICE, SARAH (MPH, MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:MPH, MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5018
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61125-0018
Mailing Address - Country:US
Mailing Address - Phone:815-544-2575
Mailing Address - Fax:
Practice Address - Street 1:5838 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4916
Practice Address - Country:US
Practice Address - Phone:815-520-7674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist