Provider Demographics
NPI:1790905651
Name:SALI, SARA R (LMP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:SALI
Suffix:
Gender:F
Credentials:LMP
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 2116
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-2116
Mailing Address - Country:US
Mailing Address - Phone:206-300-0673
Mailing Address - Fax:
Practice Address - Street 1:11700 MEADOWMEER CIR NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-4202
Practice Address - Country:US
Practice Address - Phone:206-842-5661
Practice Address - Fax:206-842-5662
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013324174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist