Provider Demographics
NPI:1275640120
Name:WESOLOSKI, SARAH E (OT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:WESOLOSKI
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 1:595 CTY TRUNK R
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:WI
Mailing Address - Zip Code:54208
Mailing Address - Country:US
Mailing Address - Phone:920-863-2005
Mailing Address - Fax:
Practice Address - Street 1:595 CTY TRUNK R
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:WI
Practice Address - Zip Code:54208
Practice Address - Country:US
Practice Address - Phone:920-863-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3268225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3268OtherLICENSE