Provider Demographics
NPI:1598527004
Name:REILLY, SARAH RAE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RAE
Last Name:REILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:OR
Mailing Address - Zip Code:97127-0102
Mailing Address - Country:US
Mailing Address - Phone:503-956-6655
Mailing Address - Fax:
Practice Address - Street 1:756 N MARKET ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:OR
Practice Address - Zip Code:97127-2070
Practice Address - Country:US
Practice Address - Phone:503-956-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000110485374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula