Provider Demographics
NPI:1467128058
Name:HAM, SARAH KATHLEEN
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHLEEN
Last Name:HAM
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 1:15955 STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:OH
Mailing Address - Zip Code:45302-9467
Mailing Address - Country:US
Mailing Address - Phone:937-658-4145
Mailing Address - Fax:
Practice Address - Street 1:15955 STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:OH
Practice Address - Zip Code:45302-9467
Practice Address - Country:US
Practice Address - Phone:937-658-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer