Provider Demographics
NPI:1376148759
Name:O'MEARA, SARA (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 SOMERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5939
Mailing Address - Country:US
Mailing Address - Phone:313-909-5474
Mailing Address - Fax:
Practice Address - Street 1:119 S WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6423
Practice Address - Country:US
Practice Address - Phone:248-572-7389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401001304103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst