Provider Demographics
NPI:1912065319
Name:WEBER, SARA (OTR L)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:W
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:13211 SHAWNEE LANE
Mailing Address - City:HUMBOLDT
Mailing Address - State:AZ
Mailing Address - Zip Code:86324-0700
Mailing Address - Country:US
Mailing Address - Phone:928-632-1111
Mailing Address - Fax:928-632-8011
Practice Address - Street 1:4710 E 29TH ST
Practice Address - Street 2:BLDG 5
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:928-848-4311
Practice Address - Fax:928-632-8011
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0422225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ770679OtherAHCCCS