Provider Demographics
NPI:1306312814
Name:WITTAK, SARAH RENEE (OTD, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:RENEE
Last Name:WITTAK
Suffix:
Gender:F
Credentials:OTD, OTR/L, CHT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:RENEE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18444 N 25TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:623-434-2115
Mailing Address - Fax:623-544-5531
Practice Address - Street 1:123 HOSPITAL DR STE 1008
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3320
Practice Address - Country:US
Practice Address - Phone:920-206-6500
Practice Address - Fax:920-261-4013
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7006-26225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand