Active NPI
Sara Skidmore
- Occupational Therapist
- Sullivan, MO
National Provider Identifier
1407954209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 004800
- Practice address
- 2022 Phoenix Drive
Sullivan, MO 63080 - Phone
- (636) 239-9979
- Fax
- (636) 239-5442
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 004800 | MO | Primary |
Addresses
Primary practice location
2022 Phoenix Drive
Sullivan, MO 63080
Mailing address
13537 Barrett Parkway Dr
Suite 105
Ballwin, MO 63021
Phone (314) 821-9126
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00422912 | Other | MO | PALMETTO GBA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004800 | MO | MD | Occupational Therapist |
Interoperability endpoints
- sara.skidmore.p2@direct.athleticoltd.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197849600000",
"number": "1407954209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13537 BARRETT PARKWAY DR",
"address_2": "SUITE 105",
"city": "BALLWIN",
"state": "MO",
"postal_code": "63021",
"telephone_number": "314-821-9126",
"fax_number": "314-821-9142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2022 PHOENIX DRIVE",
"city": "SULLIVAN",
"state": "MO",
"postal_code": "63080",
"telephone_number": "636-239-9979",
"fax_number": "636-239-5442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKIDMORE",
"first_name": "SARA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MO",
"license": "004800",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA",
"identifier": "P00422912",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sullivan, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.