Provider Demographics
NPI:1548882087
Name:MOREAU, SARAH (CLVT, COMS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MOREAU
Suffix:
Gender:F
Credentials:CLVT, COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5372 E HART LAKE LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-9356
Mailing Address - Country:US
Mailing Address - Phone:907-707-5564
Mailing Address - Fax:
Practice Address - Street 1:5372 E HART LAKE LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9356
Practice Address - Country:US
Practice Address - Phone:907-707-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171W00000X
225400000X, 2255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner