Provider Demographics
NPI:1124427091
Name:ANDERSEN, SARAH (ATC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:COON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:200 HIDDEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8513
Mailing Address - Country:US
Mailing Address - Phone:336-580-2627
Mailing Address - Fax:
Practice Address - Street 1:584 COUNTY LINE RD W
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7295
Practice Address - Country:US
Practice Address - Phone:614-355-6055
Practice Address - Fax:614-355-6072
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0055892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty