Provider Demographics
NPI:1861889917
Name:DONOVAN, SARAH (ATC, LAT, CPED)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:ATC, LAT, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAFAYETTE ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-3217
Mailing Address - Country:US
Mailing Address - Phone:603-686-2946
Mailing Address - Fax:
Practice Address - Street 1:400 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2209
Practice Address - Country:US
Practice Address - Phone:603-929-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTATR-LAT-LIC-11012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer