Provider Demographics
NPI:1740546001
Name:CERANSKI, SANDRA ANN (OTR)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:CERANSKI
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:W131S6680 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-3402
Mailing Address - Country:US
Mailing Address - Phone:414-425-0090
Mailing Address - Fax:
Practice Address - Street 1:W131S6680 KIPLING DR
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-3402
Practice Address - Country:US
Practice Address - Phone:414-425-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1102-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1102-26OtherOT LICENSE
WIAA340687OtherNBCOT REGISTRATION
WI40508300Medicaid