Provider Demographics
NPI:1346842903
Name:WHITTEN, SARA (MMT, MT-BC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:MMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 HOLLY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-6123
Mailing Address - Country:US
Mailing Address - Phone:478-719-0924
Mailing Address - Fax:
Practice Address - Street 1:4261 HOLLY HILL DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-6123
Practice Address - Country:US
Practice Address - Phone:478-719-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMUT000233225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist