Provider Demographics
NPI:1104441682
Name:STABENOW, SARA POLETTI (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:POLETTI
Last Name:STABENOW
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:POLETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 25104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85002-5104
Mailing Address - Country:US
Mailing Address - Phone:602-380-3377
Mailing Address - Fax:
Practice Address - Street 1:60 E VERNON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1337
Practice Address - Country:US
Practice Address - Phone:602-380-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020000630225X00000X
IL056013449225X00000X
AZOTH008096225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist