Provider Demographics
NPI:1093020927
Name:VANARSDALE, SANDRA M
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:M
Last Name:VANARSDALE
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 1:112 E FRAZIER AVE
Mailing Address - Street 2:PO BOX 488
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1920
Mailing Address - Country:US
Mailing Address - Phone:270-250-1606
Mailing Address - Fax:
Practice Address - Street 1:112 E FRAZIER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1920
Practice Address - Country:US
Practice Address - Phone:270-250-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist