Provider Demographics
NPI:1518085257
Name:THOMAS, SARA LEE (RD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2397 NW KINGS BLVD # 102
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:276 SE VIEWMONT AVE
Practice Address - Street 2:OFFICE 1
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1910
Practice Address - Country:US
Practice Address - Phone:541-788-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR273855Medicaid
OR273855Medicaid