Provider Demographics
NPI:1255818373
Name:KING, SARA ELLEN (MOT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELLEN
Last Name:KING
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 S OVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052-1462
Mailing Address - Country:US
Mailing Address - Phone:816-785-3561
Mailing Address - Fax:
Practice Address - Street 1:14820 E 42ND ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4775
Practice Address - Country:US
Practice Address - Phone:816-695-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018023307225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist