Provider Demographics
NPI:1316441280
Name:PRIGORAC, SARA (MS OTRL)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:PRIGORAC
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:PRIGORAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTRL
Mailing Address - Street 1:1837 OXFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:810-623-0947
Mailing Address - Fax:
Practice Address - Street 1:20816 E. 11 MILE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:313-444-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009945225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist