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General NPI Number Information
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NPI Number | 1639995152
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Entity Type | Individual
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Provider Name | SARAH BEAM
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Gender |
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Dates
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Enumeration Date | 11/30/2024
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Last Update Date | 11/30/2024
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Provider Practice Location Address
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Address Line | 3368 LYTLE RD
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City | WAYNESVILLE
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State | OH
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Zip | 45068-9640
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Country | US
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Telephone | 937-907-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 9606 CROOKED CREEK DR
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City | CENTERVILLE
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State | OH
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Zip | 45458-2962
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Country | US
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Telephone | 513-313-8825
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA008206
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License Number State | OH
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