Provider Demographics
NPI:1912613811
Name:PHILLIPS, SARAH (BS, COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:BS, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10413 CHESTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1671
Mailing Address - Country:US
Mailing Address - Phone:540-546-4552
Mailing Address - Fax:
Practice Address - Street 1:9404 THORNTON ROLLING RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1714
Practice Address - Country:US
Practice Address - Phone:540-546-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002763224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant