Provider Demographics
NPI:1053788836
Name:SIEGAL, SARA (ATC)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:SIEGAL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 LIVE OAK AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4845
Mailing Address - Country:US
Mailing Address - Phone:216-469-2246
Mailing Address - Fax:
Practice Address - Street 1:683 LIVE OAK AVE
Practice Address - Street 2:APT 5
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4845
Practice Address - Country:US
Practice Address - Phone:216-469-2246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer