Provider Demographics
NPI:1457019770
Name:EDWARDS, SARA MARIELLA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARIELLA
Last Name:EDWARDS
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:P.O. BOX 548
Mailing Address - Street 2:
Mailing Address - City:PECOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74902-0548
Mailing Address - Country:US
Mailing Address - Phone:479-739-5880
Mailing Address - Fax:
Practice Address - Street 1:9000 ROGERS AVE SUITE B
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5281
Practice Address - Country:US
Practice Address - Phone:479-522-6508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9113225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist