Provider Demographics
NPI:1902536030
Name:MARTIN, SARAH ELIZABETH (LAT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-1025
Mailing Address - Country:US
Mailing Address - Phone:417-926-5699
Mailing Address - Fax:417-926-5703
Practice Address - Street 1:1206 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1025
Practice Address - Country:US
Practice Address - Phone:417-926-5699
Practice Address - Fax:417-926-5703
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240209942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer