Provider Demographics
NPI:1053924894
Name:ROARK, SARAH MICHELLE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELLE
Last Name:ROARK
Suffix:
Gender:F
Credentials: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 1:314 W HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5425
Mailing Address - Country:US
Mailing Address - Phone:256-502-1248
Mailing Address - Fax:
Practice Address - Street 1:314 W HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5425
Practice Address - Country:US
Practice Address - Phone:256-502-1248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist