Provider Demographics
NPI:1205927019
Name:MITCHENER, SARAH LAWANDA (OTR/L)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:LAWANDA
Last Name:MITCHENER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-1220
Mailing Address - Country:US
Mailing Address - Phone:405-919-2026
Mailing Address - Fax:888-547-5376
Practice Address - Street 1:8501 NE 129TH ST
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:OK
Practice Address - Zip Code:73049-3415
Practice Address - Country:US
Practice Address - Phone:405-919-2026
Practice Address - Fax:888-547-5376
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT410225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100638110BMedicaid