Provider Demographics
NPI:1457075269
Name:CENTERWALL, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CENTERWALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-0120
Mailing Address - Country:US
Mailing Address - Phone:607-972-6593
Mailing Address - Fax:607-223-7016
Practice Address - Street 1:1062 ST ROUTE 38
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-0120
Practice Address - Country:US
Practice Address - Phone:607-972-6593
Practice Address - Fax:607-223-7016
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency