Provider Demographics
NPI:1700021979
Name:PELISHEK, SARAH R (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:R
Last Name:PELISHEK
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:1212 MEMORIAL DR
Practice Address - Street 2:STE.1
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2247
Practice Address - Country:US
Practice Address - Phone:920-652-9554
Practice Address - Fax:920-652-9556
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4037-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400176781Medicare PIN