Provider Demographics
NPI:1588363063
Name:SEBESTYEN, MARA (MS OTR)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:SEBESTYEN
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:N82W15860 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3710
Mailing Address - Country:US
Mailing Address - Phone:414-405-9312
Mailing Address - Fax:
Practice Address - Street 1:N82W15860 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3710
Practice Address - Country:US
Practice Address - Phone:414-405-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4135-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist