Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OC60109877 | WA |
NPI | 1013240514 |
---|---|
Provider Name | Sara Michelle Desrosier |
First Address | Roseau, MN 56751-8322 |
Second Address | Pullman, WA 99163-3705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2009 |
Last Update Date | 15/09/2009 |