=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518838622
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH MARIE SHELLEH OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2025
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1032 E SUMNER ST
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53027-1608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-673-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1640 E SUMNER ST
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53027-2684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 6799-26
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------