Provider Demographics
NPI:1053081067
Name:LINEBAUGH, SABRINA R
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:R
Last Name:LINEBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 W FUNDERBURG RD APT C1
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2854
Mailing Address - Country:US
Mailing Address - Phone:937-708-1310
Mailing Address - Fax:
Practice Address - Street 1:159 W FUNDERBURG RD APT C1
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2854
Practice Address - Country:US
Practice Address - Phone:937-708-1310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services