Provider Demographics
NPI:1306069588
Name:BECKER, SARA ELIZABETH (AB, MS, DT)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:ELIZABETH
Last Name:BECKER
Suffix:
Gender:F
Credentials:AB, MS, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PENN CT
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-5235
Mailing Address - Country:US
Mailing Address - Phone:217-621-3302
Mailing Address - Fax:217-328-2735
Practice Address - Street 1:2 PENN CT
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-5235
Practice Address - Country:US
Practice Address - Phone:217-621-3302
Practice Address - Fax:217-328-2735
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist