Provider Demographics
NPI:1689391419
Name:DZIEWULSKI, SARAH (COTA/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DZIEWULSKI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S ANNANDALE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6273
Mailing Address - Country:US
Mailing Address - Phone:847-542-6555
Mailing Address - Fax:
Practice Address - Street 1:1301 PYOTT RD STE 109
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-9796
Practice Address - Country:US
Practice Address - Phone:847-542-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005740224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant