Provider Demographics
NPI:1023735487
Name:MARTIN, SARA (MA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MOUNTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3953 SPYGLASS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9550
Mailing Address - Country:US
Mailing Address - Phone:440-596-7027
Mailing Address - Fax:
Practice Address - Street 1:3953 SPYGLASS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9550
Practice Address - Country:US
Practice Address - Phone:440-596-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician