Provider Demographics
NPI:1437326063
Name:KRAUSE, SARA L (OTR)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 MUIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53153-9617
Mailing Address - Country:US
Mailing Address - Phone:414-379-2777
Mailing Address - Fax:
Practice Address - Street 1:3271 NORTH ST
Practice Address - Street 2:
Practice Address - City:EAST TROY
Practice Address - State:WI
Practice Address - Zip Code:53120-1147
Practice Address - Country:US
Practice Address - Phone:262-642-3995
Practice Address - Fax:262-642-3930
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3175-026172V00000X
WI3175-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1437326063Medicaid