Provider Demographics
NPI:1174371058
Name:CARR, SARA MALINA MICHELLE (LPMT, MT-BC, NMT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MALINA MICHELLE
Last Name:CARR
Suffix:
Gender:F
Credentials:LPMT, MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 BELLINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5251
Mailing Address - Country:US
Mailing Address - Phone:706-513-9203
Mailing Address - Fax:
Practice Address - Street 1:3777 PEACHTREE RD NE APT 725
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3384
Practice Address - Country:US
Practice Address - Phone:706-513-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMUT000317225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist