Provider Demographics
NPI:1598192007
Name:STIVERS, SARAH M (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:STIVERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 SW MORRISON ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2635
Mailing Address - Country:US
Mailing Address - Phone:503-896-9139
Mailing Address - Fax:
Practice Address - Street 1:1017 SW MORRISON ST
Practice Address - Street 2:SUITE 312
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2635
Practice Address - Country:US
Practice Address - Phone:503-896-9139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-28
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist