Provider Demographics
NPI:1932931292
Name:KABAKOV, SABRINA ALEXSANDRA (OTD)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:ALEXSANDRA
Last Name:KABAKOV
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7169 E PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-9403
Mailing Address - Country:US
Mailing Address - Phone:608-286-1171
Mailing Address - Fax:833-699-2154
Practice Address - Street 1:1738 EAGAN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3736
Practice Address - Country:US
Practice Address - Phone:608-286-1171
Practice Address - Fax:833-699-2154
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8654-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist