Provider Demographics
NPI:1508644055
Name:SUDDARTH, SARAH KATHERINE (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHERINE
Last Name:SUDDARTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATHERINE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1750 E GRAND RIVER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4958
Mailing Address - Country:US
Mailing Address - Phone:616-541-4124
Mailing Address - Fax:
Practice Address - Street 1:1750 E GRAND RIVER AVE STE 103
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4958
Practice Address - Country:US
Practice Address - Phone:616-541-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501009522225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist