Provider Demographics
NPI:1285071365
Name:REILLY, SARAH ELIZABETH (ATC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:REILLY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 OBSERVATORY AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2237
Mailing Address - Country:US
Mailing Address - Phone:513-304-2043
Mailing Address - Fax:
Practice Address - Street 1:2745 OBSERVATORY AVE
Practice Address - Street 2:APT 6
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2237
Practice Address - Country:US
Practice Address - Phone:513-304-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0039572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer