Provider Demographics
NPI:1508122359
Name:BLACKMON, SARAH E (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HAYS ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-9129
Mailing Address - Country:US
Mailing Address - Phone:870-565-6113
Mailing Address - Fax:
Practice Address - Street 1:154 CORNERSTONE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6560
Practice Address - Country:US
Practice Address - Phone:501-525-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190747721Medicaid