Provider Demographics
NPI:1831267830
Name:PHILLIPS, SARA EVANS (OTRL)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:EVANS
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 BARRETT KNOLL CIR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-8208
Mailing Address - Country:US
Mailing Address - Phone:770-423-0644
Mailing Address - Fax:
Practice Address - Street 1:2217 ROSWELL RD STE 100A
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2966
Practice Address - Country:US
Practice Address - Phone:770-321-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist