Provider Demographics
NPI:1285022046
Name:MALLAMS, SARA (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:MALLAMS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 S. LINCOLN ST.
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166
Mailing Address - Country:US
Mailing Address - Phone:715-526-6111
Mailing Address - Fax:
Practice Address - Street 1:7305 NANTUCKET CT
Practice Address - Street 2:1A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-1294
Practice Address - Country:US
Practice Address - Phone:715-853-5753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005738A225X00000X
IA075376225X00000X
WI6234-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist