Provider Demographics
NPI:1386899219
Name:BIGELOW, SANDRA (OTR/L)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 S MACADAM AVE
Mailing Address - Street 2:STE 258, PMB 524
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2451
Mailing Address - Country:US
Mailing Address - Phone:917-442-4749
Mailing Address - Fax:
Practice Address - Street 1:44 W 74TH ST
Practice Address - Street 2:APT. 2D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2451
Practice Address - Country:US
Practice Address - Phone:917-442-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008475-1225XP0200X
OR1014661225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics