Healthcare Provider Details

I. General information

NPI: 1639903131
Provider Name (Legal Business Name): SARA J DEBLAEY RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W LINCOLN AVE FL 2
WEST ALLIS WI
53227-2409
US

IV. Provider business mailing address

3060 BARRY ST
HUDSONVILLE MI
49426-9493
US

V. Phone/Fax

Practice location:
  • Phone: 414-328-7700
  • Fax:
Mailing address:
  • Phone: 231-527-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: