Provider Demographics
NPI:1609191717
Name:MAYER, SALLY
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:MAYER
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 1:2109 BISHOP CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-6114
Mailing Address - Country:US
Mailing Address - Phone:785-331-8393
Mailing Address - Fax:
Practice Address - Street 1:350 INTERLOCKEN BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-3477
Practice Address - Country:US
Practice Address - Phone:720-536-2392
Practice Address - Fax:303-962-4819
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic