Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT.0005573 | CO |
NPI | 1003575754 |
---|---|
Provider Name | Sarah Elyse Mcdonald |
First Address | Pueblo, CO 81005-3361 |
Second Address | Pueblo, CO 81005-2651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2021 |
Last Update Date | 09/12/2021 |