Provider Demographics
NPI:1588418875
Name:MESTROVIC, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MESTROVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 AVONDALE DR APT 201
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-6005
Mailing Address - Country:US
Mailing Address - Phone:304-575-3771
Mailing Address - Fax:
Practice Address - Street 1:30 AVONDALE DR APT 201
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-6005
Practice Address - Country:US
Practice Address - Phone:304-575-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC2369224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant