Provider Demographics
NPI:1104388552
Name:RUPP, SARAH LYNN
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:RUPP
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 1:818 N COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2061
Mailing Address - Country:US
Mailing Address - Phone:316-871-4701
Mailing Address - Fax:
Practice Address - Street 1:601 N ROSE HILL RD
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:KS
Practice Address - Zip Code:67133-9336
Practice Address - Country:US
Practice Address - Phone:316-776-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01238224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant