Provider Demographics
NPI:1376905042
Name:ROBERTS, SARA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ROBERTS
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 1:328 RUSSELL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5313
Mailing Address - Country:US
Mailing Address - Phone:608-843-6736
Mailing Address - Fax:
Practice Address - Street 1:9401 OLD SAUK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-4409
Practice Address - Country:US
Practice Address - Phone:608-203-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0003961225X00000X
WI6141-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist