Provider Demographics
NPI:1972038131
Name:MCDERMITT, SARA (MT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MCDERMITT
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:3000 W MEMORIAL RD
Mailing Address - Street 2:SUITE #112 - ROOM #5
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6101
Mailing Address - Country:US
Mailing Address - Phone:405-343-9870
Mailing Address - Fax:
Practice Address - Street 1:3000 W MEMORIAL RD
Practice Address - Street 2:SUITE #112 - ROOM #5
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6101
Practice Address - Country:US
Practice Address - Phone:405-343-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK172517225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist