Individual
SARA LYNN BANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19 FAIRVIEW TER, GREAT BARRINGTON, MA 01230-1264
(413) 329-4840
Mailing address
19 FAIRVIEW TER, GREAT BARRINGTON, MA 01230-1264
(413) 329-4840
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
436236
MA
Other
Enumeration date
09/12/2011
Last updated
09/12/2011
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