Provider Demographics
NPI:1437823432
Name:REDISKE, SARAH (MOT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:REDISKE
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 E 61ST ST STE 500
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1208
Mailing Address - Country:US
Mailing Address - Phone:918-582-6800
Mailing Address - Fax:918-582-6060
Practice Address - Street 1:2431 E 61ST ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1229
Practice Address - Country:US
Practice Address - Phone:918-582-6800
Practice Address - Fax:918-582-6060
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60480430225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist