Provider Demographics
NPI:1992875439
Name:PETERMAN, SARAH A (OTRL)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:A
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:450 LAUREL ST
Mailing Address - Street 2:STE A
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3045
Mailing Address - Country:US
Mailing Address - Phone:515-699-8378
Mailing Address - Fax:515-248-8888
Practice Address - Street 1:309 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1750
Practice Address - Country:US
Practice Address - Phone:515-965-5311
Practice Address - Fax:515-963-5301
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01321225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172063Medicare PIN
IAI19172Medicare PIN