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General NPI Number Information
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NPI Number | 1619393279
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Entity Type | Individual
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Provider Name | SARAH MOTL
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Gender | Female
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 257 W SAINT GEORGE AVE
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City | GRANTSBURG
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State | WI
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Zip | 54840-7827
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Country | US
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Telephone | 715-463-7273
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Fax | 715-463-2423
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Provider Business Mailing Address
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Address Line | 416 S PINE ST APT 10
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City | GRANTSBURG
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State | WI
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Zip | 54840-4405
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Country | US
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Telephone | 651-746-9362
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Fax | 715-463-2423
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1087139
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License Number State | MN
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