Provider Demographics
NPI:1871577908
Name:TCHOBANOFF, SARA (OTR)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:TCHOBANOFF
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6448
Mailing Address - Country:US
Mailing Address - Phone:916-782-2761
Mailing Address - Fax:916-751-2430
Practice Address - Street 1:2600 EUREKA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6448
Practice Address - Country:US
Practice Address - Phone:916-782-2761
Practice Address - Fax:916-751-2430
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7998225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT7998AMedicare ID - Type UnspecifiedMEDICARE ID NUMBER