MEDICARE: MRS. SARAH BLACKMORE BCBA

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

General Provider Information

NPI Number	:	1841947983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH BLACKMORE BCBA

Provider Business Mailing Address
First Line	:	2658 VIOLET WAY
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6364
Country	:	US
Telephone Number	:	812-371-1519
Fax Number	:

Provider Business Practice Location Address
First Line	:	2658 VIOLET WAY
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6364
Country	:	US
Telephone Number	:	812-371-1519
Fax Number	:

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

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	02/19/2026

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