Provider Demographics
NPI:1841545084
Name:EZERINS, SARAH A (OT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:EZERINS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:HOPPE
Other - Suffix:
Other - Last Name Type:Former Name
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:
Mailing Address - Fax:
Practice Address - Street 1:2835 N GRANDVIEW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5546
Practice Address - Country:US
Practice Address - Phone:262-574-1100
Practice Address - Fax:262-574-5193
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225X00000X
WI5214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100023991Medicaid