Provider Demographics
NPI:1538636329
Name:KILEY, SARA ANN (MT-BC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:KILEY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1704
Mailing Address - Country:US
Mailing Address - Phone:724-816-7958
Mailing Address - Fax:
Practice Address - Street 1:206 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1704
Practice Address - Country:US
Practice Address - Phone:724-816-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA08688225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty