Provider Demographics
NPI:1093912255
Name:KELLER, SARAH M (OTR)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:KELLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:N1765 SAUK TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:OOSTBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53070-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1125 N 13TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3281
Practice Address - Country:US
Practice Address - Phone:920-208-9648
Practice Address - Fax:920-208-6316
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1891-026225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics