Provider Demographics
NPI:1972994895
Name:O'GRADY, STEPHANIE SAUER (OTR, DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SAUER
Last Name:O'GRADY
Suffix:
Gender:F
Credentials:OTR, DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:D
Other - Last Name:SAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, DPT
Mailing Address - Street 1:2500 E PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9718
Mailing Address - Country:US
Mailing Address - Phone:970-493-0112
Mailing Address - Fax:970-493-0521
Practice Address - Street 1:1610 DRY CREEK DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6405
Practice Address - Country:US
Practice Address - Phone:720-494-4750
Practice Address - Fax:720-494-4751
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013116225100000X
COOT.0005341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68-6520OtherMEDICARE ID