Provider Demographics
NPI:1366765018
Name:LOESCH, SARA LYNN (MS,OTR/L)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:LOESCH
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:BOBERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:171 MADISON AVE
Mailing Address - Street 2:FL 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5110
Mailing Address - Country:US
Mailing Address - Phone:212-400-0383
Mailing Address - Fax:
Practice Address - Street 1:171 MADISON AVE
Practice Address - Street 2:FL 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5110
Practice Address - Country:US
Practice Address - Phone:212-400-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016048-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist