Healthcare Provider Details

I. General information

NPI: 1851761068
Provider Name (Legal Business Name): SARAH HUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH COCHLIN LMSW

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 11/16/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N FAIRLAND ST
PRYOR OK
74361-4205
US

IV. Provider business mailing address

109 SOUTH FAIRLAND ST
PRYOR OK
74361-4203
US

V. Phone/Fax

Practice location:
  • Phone: 918-825-1405
  • Fax: 918-825-1406
Mailing address:
  • Phone: 918-825-1405
  • Fax: 918-825-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7010
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: