Provider Demographics
NPI:1124304050
Name:GORANSON, SARAH ANN (MS, OTR)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANN
Last Name:GORANSON
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6014 CORAL CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-7425
Mailing Address - Country:US
Mailing Address - Phone:920-475-1579
Mailing Address - Fax:
Practice Address - Street 1:1700 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1230
Practice Address - Country:US
Practice Address - Phone:920-739-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
WI5086-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist