Provider Demographics
NPI:1972825933
Name:WEBB, SARA JACQUELINE (CERTIFICATE: LMP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JACQUELINE
Last Name:WEBB
Suffix:
Gender:F
Credentials:CERTIFICATE: LMP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JACQUELINE
Other - Last Name:SCHOLLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CERTIFICATE: LMP
Mailing Address - Street 1:1270 SW WILLIAM AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-4730
Mailing Address - Country:US
Mailing Address - Phone:360-748-8814
Mailing Address - Fax:
Practice Address - Street 1:1270 SW WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-4730
Practice Address - Country:US
Practice Address - Phone:360-748-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist