1558675843 NPI number — SARAH FEELEY METZGER-HEGEMAN MS OTR/L

Table of content: DR. TIMOTHY PATRICK SULLIVAN MD (NPI 1154408011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558675843 NPI number — SARAH FEELEY METZGER-HEGEMAN MS OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
METZGER-HEGEMAN
Provider First Name:
SARAH
Provider Middle Name:
FEELEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
METZGER
Provider Other First Name:
SARAH
Provider Other Middle Name:
FEELEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558675843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3080 TIMPANA PT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32779-3108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-970-2438
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1809 E BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-8597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-222-6622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  15830 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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