Provider Demographics
NPI:1770364580
Name:NELSON, SARAH (BACHELOR OF SCIENCE)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:HALLIDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BACHELOR OF SCIENCE
Mailing Address - Street 1:1 SPRUCEDALE DR
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1396
Mailing Address - Country:US
Mailing Address - Phone:631-449-5783
Mailing Address - Fax:
Practice Address - Street 1:486 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1386
Practice Address - Country:US
Practice Address - Phone:508-764-7693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist