Provider Demographics
NPI:1629633862
Name:DITORRICE, SARAH MARGARET
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARGARET
Last Name:DITORRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ZECK CT
Mailing Address - Street 2:
Mailing Address - City:DOUSMAN
Mailing Address - State:WI
Mailing Address - Zip Code:53118-8816
Mailing Address - Country:US
Mailing Address - Phone:262-212-2190
Mailing Address - Fax:
Practice Address - Street 1:220 ZECK CT
Practice Address - Street 2:
Practice Address - City:DOUSMAN
Practice Address - State:WI
Practice Address - Zip Code:53118-8816
Practice Address - Country:US
Practice Address - Phone:262-212-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer