Provider Demographics
NPI:1912306168
Name:RICHARDSON, SARA KATHERINE (ATC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KATHERINE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:KATHERINE
Other - Last Name:HEMMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:7541 CHATTERTON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-9680
Mailing Address - Country:US
Mailing Address - Phone:765-506-3652
Mailing Address - Fax:
Practice Address - Street 1:8499 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2335
Practice Address - Country:US
Practice Address - Phone:317-495-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001827A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer