MEDICARE: SARA MUTAHAR RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1225820798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA MUTAHAR RBT

Provider Business Mailing Address
First Line	:	5687 NE GLISAN ST UNIT 15
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-3474
Country	:	US
Telephone Number	:	503-521-6771
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 SE SHERMAN ST STE B
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4666
Country	:	US
Telephone Number	:	864-621-7408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	05/20/2025

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Directions to “ SARA MUTAHAR RBT” Practice Location

Language	Start Address	Practice Location

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