Provider Demographics
NPI:1427622562
Name:LIVELY, SARAH JO (ERYT-500, MSHWC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JO
Last Name:LIVELY
Suffix:
Gender:F
Credentials:ERYT-500, MSHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 CORNHUSKER RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-2410
Mailing Address - Country:US
Mailing Address - Phone:402-739-9176
Mailing Address - Fax:
Practice Address - Street 1:2308 CORNHUSKER RD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-2410
Practice Address - Country:US
Practice Address - Phone:402-739-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation