Provider Demographics
NPI:1104951748
Name:MARRIOTT, SARAH ELIZABETH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:GEIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:300 DOODRIDGE
Mailing Address - City:BLACKWATER
Mailing Address - State:MO
Mailing Address - Zip Code:65322-0117
Mailing Address - Country:US
Mailing Address - Phone:660-846-2461
Mailing Address - Fax:660-846-2431
Practice Address - Street 1:300 DOODRIDGE
Practice Address - Street 2:BLACKWATER R-II
Practice Address - City:BLACKWATER
Practice Address - State:MO
Practice Address - Zip Code:65322-0117
Practice Address - Country:US
Practice Address - Phone:660-846-2461
Practice Address - Fax:660-846-2431
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001031723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO465687036Medicaid