Provider Demographics
NPI:1871991075
Name:TRUEB, SARAH (CMT LMT MMT)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:TRUEB
Suffix:
Gender:F
Credentials:CMT LMT MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROFESSIONAL CT STE 3
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5129
Mailing Address - Country:US
Mailing Address - Phone:765-505-7246
Mailing Address - Fax:
Practice Address - Street 1:30 PROFESSIONAL CT STE 3
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5129
Practice Address - Country:US
Practice Address - Phone:765-505-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-21
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT#20902941247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other