Provider Demographics
NPI:1215319900
Name:WILSON, SARAH (LMT)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N BAKER ST TRLR 31
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-9287
Mailing Address - Country:US
Mailing Address - Phone:509-866-3233
Mailing Address - Fax:
Practice Address - Street 1:103 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8960
Practice Address - Country:US
Practice Address - Phone:509-935-2225
Practice Address - Fax:509-935-2273
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60319442225700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist