Provider Demographics
NPI:1790907178
Name:ALFSON, SARA ANN (COTA)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:ANN
Last Name:ALFSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 FROST RD
Mailing Address - Street 2:APT. 7
Mailing Address - City:HOWARDS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53083-5702
Mailing Address - Country:US
Mailing Address - Phone:920-646-0009
Mailing Address - Fax:
Practice Address - Street 1:1235 S 24TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5516
Practice Address - Country:US
Practice Address - Phone:920-646-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2042-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant