Provider Demographics
NPI:1508942152
Name:FLEISHMAN, SARA FAYE
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:FAYE
Last Name:FLEISHMAN
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 1:13820 S 44TH ST
Mailing Address - Street 2:APARTMENT 1210
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4849
Mailing Address - Country:US
Mailing Address - Phone:480-491-5754
Mailing Address - Fax:480-491-5754
Practice Address - Street 1:13820 S 44TH ST
Practice Address - Street 2:APARTMENT 1210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4849
Practice Address - Country:US
Practice Address - Phone:480-491-5754
Practice Address - Fax:480-491-5754
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3177225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ844226Medicaid
1063416OtherNBCOT
AZ2298OtherSIPT CERTIFICATE