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General NPI Number Information
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NPI Number | 1447140785
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Entity Type | Individual
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Provider Name | SARAH P DEROSE
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Gender | Female
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 9255 N 76TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53223-1058
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Country | US
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Telephone | 414-357-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 6060 S CROSSWINDS DR UNIT 1
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City | CUDAHY
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State | WI
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Zip | 53110-3416
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5814-27
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License Number State | WI
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