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NPI Code Detail

MEDICARE: MRS. SARA MARIELLA EDWARDS LMT

MEDICARE:  MRS. SARA MARIELLA EDWARDS  LMT
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
1225700000XMassage Therapist9113AR

General Provider Information

NPI Number : 1457019770
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SARA MARIELLA EDWARDS LMT
Provider Business Mailing Address
First Line : P.O. BOX 548
Second Line :
City : PECOLA
State : OK
Zip : 74902-0548
Country : US
Telephone Number : 479-739-5880
Fax Number :
Provider Business Practice Location Address
First Line : 9000 ROGERS AVE SUITE B
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-5281
Country : US
Telephone Number : 479-522-6508
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2021
Last Update Date : 12/03/2021

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Directions to “ MRS. SARA MARIELLA EDWARDS LMT” Practice Location

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