Provider Demographics
NPI:1619607413
Name:BICKLER, SARA GOODALL
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:GOODALL
Last Name:BICKLER
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 1:10805 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4729
Mailing Address - Country:US
Mailing Address - Phone:703-978-8400
Mailing Address - Fax:
Practice Address - Street 1:10805 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4729
Practice Address - Country:US
Practice Address - Phone:703-978-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics