Basic Information
| Provider Information | |||||||||
| NPI: | 1023471406 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIEBERG | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 281 BUTTERWORTH ST APT 2 | ||||||||
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| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560011120 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 SAINT ANDREWS CT STE 310 | ||||||||
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| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560018805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073885437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2016 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 105133 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.