Provider Demographics
NPI:1992140503
Name:MAREAN, SARA DANIELLE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:DANIELLE
Last Name:MAREAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:KOLB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:15555 CAROB CIR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4407
Mailing Address - Country:US
Mailing Address - Phone:612-275-9109
Mailing Address - Fax:
Practice Address - Street 1:15555 CAROB CIR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4407
Practice Address - Country:US
Practice Address - Phone:612-275-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4782252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000173984Medicaid