Sara Probasco Vivoda, MOT, OTR/L, CLC
Occupational Therapist in Chicago, IL. Individual provider (NPI-1).
NPI number1124377635
StatusActive
Last updated in NPPESOct 1, 2025
Details
- NPI
- 1124377635
- Entity type
- Individual (NPI-1)
- Name
- Sara Probasco Vivoda
- Credential
- MOT, OTR/L, CLC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 30, 2012
- Certification date
- Oct 1, 2025
- Last updated
- Oct 1, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225X00000X | Occupational Therapist | 056.009836 | IL | Yes |
| 225XF0002X | Occupational Therapist, Feeding, Eating & Swallowing | 056.009836 | IL | |
| 174N00000X | Lactation Consultant, Non-RN | – | IL |
Other names
- Sara Kaitlyn Probasco (Former Name)
Practice location
1757 N Kimball Ave Ste 205aChicago, IL 60647-4805
Phone 816-914-0359
Mailing address
1757 N Kimball Ave Ste 205aChicago, IL 60647-4805
Phone 816-914-0359
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