Healthcare Provider Details

I. General information

NPI: 1295352755
Provider Name (Legal Business Name): SARAH CARLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 GILMORE RIDGE RD
NASHVILLE IN
47448-9731
US

IV. Provider business mailing address

9900 GILMORE RIDGE RD
NASHVILLE IN
47448-9731
US

V. Phone/Fax

Practice location:
  • Phone: 813-322-0313
  • Fax: 812-610-1814
Mailing address:
  • Phone: 813-322-0313
  • Fax: 812-610-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-116597
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: