Provider Demographics
NPI:1932984564
Name:STANCIL, SARA ABIGAIL
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ABIGAIL
Last Name:STANCIL
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 1:1125 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8101
Mailing Address - Country:US
Mailing Address - Phone:423-388-8286
Mailing Address - Fax:
Practice Address - Street 1:181 DUNLAP RD
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-6333
Practice Address - Country:US
Practice Address - Phone:423-323-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3997224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant