Provider Demographics
NPI:1659664290
Name:VENABLE, SARA KATHLEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KATHLEEN
Last Name:VENABLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:KATHLEEN
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1100 SHERWOOD PARK DR NE
Practice Address - Street 2:STE 140
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3424
Practice Address - Country:US
Practice Address - Phone:770-297-7750
Practice Address - Fax:770-297-1026
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0017762255A2300X
GAOT006106225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer