Provider Demographics
NPI:1568574275
Name:FULMER, SARA ANN (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:FULMER
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 1:36 BRANNON RD
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9201
Mailing Address - Country:US
Mailing Address - Phone:501-733-0084
Mailing Address - Fax:
Practice Address - Street 1:302 AVENUE 2 NW
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:AR
Practice Address - Zip Code:72823-4139
Practice Address - Country:US
Practice Address - Phone:501-208-3564
Practice Address - Fax:501-336-8235
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1954225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y137OtherBLUE CROSS BLUE SHIELD