Provider Demographics
NPI:1861243610
Name:ETHEREDGE, SARAH KATE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATE
Last Name:ETHEREDGE
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 1:660 MCQUEEN SMITH RD N STE H
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7559
Mailing Address - Country:US
Mailing Address - Phone:334-334-3362
Mailing Address - Fax:
Practice Address - Street 1:660 MCQUEEN SMITH RD N STE H
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7559
Practice Address - Country:US
Practice Address - Phone:334-334-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist