Provider Demographics
NPI:1275992695
Name:KEITH-KNEPP, SARA ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:KEITH-KNEPP
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 STATE ROUTE 43 STE 111
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6579
Mailing Address - Country:US
Mailing Address - Phone:330-221-4899
Mailing Address - Fax:
Practice Address - Street 1:4030 STATE ROUTE 43 STE 111
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6579
Practice Address - Country:US
Practice Address - Phone:330-221-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022133 H-K225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist