Healthcare Provider Details

I. General information

NPI: 1609414747
Provider Name (Legal Business Name): SARAH BATEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9256 BENDIX RD STE 105106
COLUMBIA MD
21045-1840
US

IV. Provider business mailing address

PO BOX 1343
CLARKSTON MI
48347-1343
US

V. Phone/Fax

Practice location:
  • Phone: 410-796-8499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: