Provider Demographics
NPI:1689859944
Name:SURPRENANT, SARAH RENEE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:RENEE
Last Name:SURPRENANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3905 W ERNESTINE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5800
Mailing Address - Country:US
Mailing Address - Phone:618-993-6237
Mailing Address - Fax:618-997-3529
Practice Address - Street 1:3905 W ERNESTINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5800
Practice Address - Country:US
Practice Address - Phone:618-993-6237
Practice Address - Fax:618-997-3529
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213486OtherGROUP
DG7011OtherRAILROAD MEDICARE
DG7011OtherRAILROAD MEDICARE