Provider Demographics
NPI:1609481647
Name:WOODGEARD, SARAH L
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:WOODGEARD
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 1:5748 RAUCH RD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9650
Mailing Address - Country:US
Mailing Address - Phone:740-756-9158
Mailing Address - Fax:
Practice Address - Street 1:5748 RAUCH RD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9650
Practice Address - Country:US
Practice Address - Phone:740-756-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2666860Medicaid
OH537980OtherATN NUMBER
OH2301646OtherOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES PROVIDER NUMBER