Provider Demographics
NPI:1588499289
Name:BOTHWELL, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BOTHWELL
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 1:2521 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30428-2121
Mailing Address - Country:US
Mailing Address - Phone:717-858-8995
Mailing Address - Fax:
Practice Address - Street 1:214 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5226
Practice Address - Country:US
Practice Address - Phone:478-353-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach