Provider Demographics
NPI:1487981825
Name:PETKO, SARA ANNE (MS,OTR/L)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:PETKO
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E NORTH ST
Mailing Address - Street 2:BUFFALO HEARING & SPEECH CENTER
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1002
Mailing Address - Country:US
Mailing Address - Phone:716-885-8871
Mailing Address - Fax:716-923-1537
Practice Address - Street 1:50 E NORTH ST
Practice Address - Street 2:BUFFALO HEARING & SPEECH CENTER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1002
Practice Address - Country:US
Practice Address - Phone:716-885-8871
Practice Address - Fax:716-923-1537
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004909976Medicaid