Provider Demographics
NPI:1790448066
Name:STICE, SARAH (FSP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:STICE
Suffix:
Gender:F
Credentials:FSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18390 S PRAIRIE BELL RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:OK
Mailing Address - Zip Code:74445-2143
Mailing Address - Country:US
Mailing Address - Phone:918-758-8070
Mailing Address - Fax:
Practice Address - Street 1:323 W 6TH ST # 5019
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5019
Practice Address - Country:US
Practice Address - Phone:918-756-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator