Healthcare Provider Details

I. General information

NPI: 1023604816
Provider Name (Legal Business Name): SARAH ANNA KAPPES MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ANNA LEREW MT-BC

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12276 SAN JOSE BLVD STE 508
JACKSONVILLE FL
32223-8618
US

IV. Provider business mailing address

12276 SAN JOSE BLVD STE 508
JACKSONVILLE FL
32223-8618
US

V. Phone/Fax

Practice location:
  • Phone: 904-886-3228
  • Fax: 904-485-8876
Mailing address:
  • Phone: 904-886-3228
  • Fax: 904-485-8876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number15724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: