Provider Demographics
NPI:1407811151
Name:MOTL, SARAH M (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:MOTL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 S IOWA ST
Mailing Address - Street 2:STE 102
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1900
Mailing Address - Country:US
Mailing Address - Phone:608-935-3301
Mailing Address - Fax:608-935-3823
Practice Address - Street 1:833 S IOWA ST
Practice Address - Street 2:STE 102
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1900
Practice Address - Country:US
Practice Address - Phone:608-935-3301
Practice Address - Fax:608-935-3853
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1770-023363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1407811151Medicaid
WIK400177032Medicare PIN
WIP01536230Medicare PIN
WI2016032OtherPHYSICIANS PLUS
WI070017011Medicare PIN
WI60492OtherDEAN HEALTH INSURANCE