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NPI Code Detail

MEDICARE: SARA GRACE CORNWELL

MEDICARE: SARA GRACE CORNWELL
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
1106S00000XBehavior TechnicianRBT-20-125995IN
2103K00000XBehavior Analyst1-24-72758IN

General Provider Information

NPI Number : 1740807148
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA GRACE CORNWELL
Provider Business Mailing Address
First Line : 7901 E 88TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-1235
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 399 HOSPITAL LN
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47802-4394
Country : US
Telephone Number : 812-645-2308
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2020
Last Update Date : 05/13/2025

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Directions to “ SARA GRACE CORNWELL ” Practice Location

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