Provider Demographics
NPI:1346889300
Name:GRAEF, SARAH MARIE (MT, BCTMB)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:GRAEF
Suffix:
Gender:F
Credentials:MT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1720
Mailing Address - Country:US
Mailing Address - Phone:715-928-3628
Mailing Address - Fax:
Practice Address - Street 1:413 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1720
Practice Address - Country:US
Practice Address - Phone:715-928-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-22
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11662OtherSTATE OF WISCONSIN LICENSURE
WI558306-08OtherBCTMB