Provider Demographics
NPI:1144433483
Name:VOGT, SHERRI (OTR)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:VOGT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:
Other - Last Name:ELLEFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:36500 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-434-2600
Mailing Address - Fax:262-434-2601
Practice Address - Street 1:36500 AURORA DR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:WI
Practice Address - Zip Code:53066
Practice Address - Country:US
Practice Address - Phone:262-434-2600
Practice Address - Fax:262-434-2601
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4239026225X00000X
WI225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40883200Medicaid