Provider Demographics
NPI:1255961223
Name:BACON, SARAH ALTA
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ALTA
Last Name:BACON
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 1:8505 E TEMPLE DR UNIT 464
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2542
Mailing Address - Country:US
Mailing Address - Phone:303-324-5663
Mailing Address - Fax:
Practice Address - Street 1:8505 E TEMPLE DR UNIT 464
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2542
Practice Address - Country:US
Practice Address - Phone:303-324-5663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist