Provider Demographics
NPI:1346795028
Name:HOUGHTON, SALLY KIM
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:KIM
Last Name:HOUGHTON
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 1:9 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3825
Mailing Address - Country:US
Mailing Address - Phone:516-427-8583
Mailing Address - Fax:
Practice Address - Street 1:9 WEST AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3825
Practice Address - Country:US
Practice Address - Phone:516-427-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program