Provider Demographics
NPI:1881020485
Name:MERCER, SARA GAIL
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:GAIL
Last Name:MERCER
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 1:8575 CORYDON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47136-9434
Mailing Address - Country:US
Mailing Address - Phone:502-619-0180
Mailing Address - Fax:
Practice Address - Street 1:303 N HURSTBOURNE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5158
Practice Address - Country:US
Practice Address - Phone:502-412-5847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002505A224Z00000X
KYKY-A56597224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant