Provider Demographics
NPI:1699132449
Name:O'TOOL, SARA JO (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JO
Last Name:O'TOOL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JO
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:208 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1357
Mailing Address - Country:US
Mailing Address - Phone:515-310-0155
Mailing Address - Fax:
Practice Address - Street 1:2400 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4664
Practice Address - Country:US
Practice Address - Phone:641-424-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081166133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered