Provider Demographics
NPI:1922314335
Name:CEARLOCK, SARA ANNE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANNE
Last Name:CEARLOCK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:ANNE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:136 E PALMER ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-2569
Mailing Address - Country:US
Mailing Address - Phone:217-823-0642
Mailing Address - Fax:
Practice Address - Street 1:136 E PALMER ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-2569
Practice Address - Country:US
Practice Address - Phone:217-823-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.003079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist