Healthcare Provider Details

I. General information

NPI: 1861925315
Provider Name (Legal Business Name): SARAH SMART OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6128 E 38TH ST
TULSA OK
74135-5832
US

IV. Provider business mailing address

6128 E 38TH ST
TULSA OK
74135-5832
US

V. Phone/Fax

Practice location:
  • Phone: 918-835-8691
  • Fax:
Mailing address:
  • Phone: 918-835-8691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1490
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: