Provider Demographics
NPI:1265005672
Name:BERLIN, SARA LACEY
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LACEY
Last Name:BERLIN
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 1:16410 84TH ST NE # D488
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9060
Mailing Address - Country:US
Mailing Address - Phone:425-319-7970
Mailing Address - Fax:
Practice Address - Street 1:11932 169TH DR NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-5858
Practice Address - Country:US
Practice Address - Phone:425-319-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist