Provider Demographics
NPI:1144645086
Name:KENDALL, SARA (LAC, MAOM)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 PINE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4726
Mailing Address - Country:US
Mailing Address - Phone:802-734-4028
Mailing Address - Fax:
Practice Address - Street 1:431 PINE ST STE 201
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4726
Practice Address - Country:US
Practice Address - Phone:207-607-2254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-02
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0134001171100000X
MEAC423171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist