Provider Demographics
NPI:1912630047
Name:ESTUDILLO, SARAH IRIS (OTD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:IRIS
Last Name:ESTUDILLO
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:IRIS
Other - Last Name:GERVAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 PALOMINO CIR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3800
Mailing Address - Country:US
Mailing Address - Phone:847-361-1731
Mailing Address - Fax:
Practice Address - Street 1:8200 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:847-361-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics