MEDICARE: SARAH POWELL

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	103K00000X	Behavior Analyst	1-14-17403	CA

General Provider Information

NPI Number	:	1811354319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH POWELL

Provider Business Mailing Address
First Line	:	10 VIA VINCA
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1053
Country	:	US
Telephone Number	:	831-334-5135
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 S MAIN ST
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-2403
Country	:	US
Telephone Number	:	831-753-5600
Fax Number	:

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

Provider Enumeration Date	:	01/28/2016
Last Update Date	:	09/02/2019

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