Provider Demographics
NPI:1083178644
Name:GRONEMUS, SARAH ANN (OT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:GRONEMUS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665
Mailing Address - Country:US
Mailing Address - Phone:608-637-4388
Mailing Address - Fax:
Practice Address - Street 1:407 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665
Practice Address - Country:US
Practice Address - Phone:608-637-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist