Provider Demographics
NPI:1720795982
Name:NIEMAN, SARAH J
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:NIEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:CONKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4682
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84323-4682
Mailing Address - Country:US
Mailing Address - Phone:907-215-4846
Mailing Address - Fax:435-774-1919
Practice Address - Street 1:3831 E BLUE LUPINE DR STE B
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8461
Practice Address - Country:US
Practice Address - Phone:907-215-4846
Practice Address - Fax:907-215-4847
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK197106225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist