Provider Demographics
NPI:1700296944
Name:PETERS, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PETERS
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 1:32671 VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:COBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97408-9201
Mailing Address - Country:US
Mailing Address - Phone:541-968-4507
Mailing Address - Fax:
Practice Address - Street 1:460 COBURG RD
Practice Address - Street 2:SUITE 306
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5531
Practice Address - Country:US
Practice Address - Phone:541-334-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20375225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist