Provider Demographics
NPI:1508043548
Name:HOUGHTON, SARAH L (LD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 E 31ST CT
Mailing Address - Street 2:STE 210
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1315
Mailing Address - Country:US
Mailing Address - Phone:918-392-4477
Mailing Address - Fax:918-392-4465
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:STE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-294-6845
Practice Address - Fax:918-294-6853
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1511133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200194410AMedicaid
OK200194410AMedicaid