Provider Demographics
NPI:1417597584
Name:MCSWEENEY, SARAH ASHLEY (ATC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ASHLEY
Last Name:MCSWEENEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 NW FLANDERS ST APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3450
Mailing Address - Country:US
Mailing Address - Phone:707-338-6867
Mailing Address - Fax:
Practice Address - Street 1:2105 NW FLANDERS ST APT 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3450
Practice Address - Country:US
Practice Address - Phone:707-338-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBOC3016032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer