Sara Probasco Vivoda, MOT, OTR/L, CLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056.009836 Issued in IL

Practice address

1757 N Kimball Ave Ste 205a
Chicago, IL 60647-4805

Phone

(816) 914-0359

NPI assigned

Aug 30, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Sara Kaitlyn Probasco Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clementine Pediatrics, LLC

  • Occupational Therapist
  • Chicago, IL
  • NPI 1134905482

  Lactation Consultant, Non-RN

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1124377635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1757 N KIMBALL AVE STE 205A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606474805",
            "telephone_number": "816-914-0359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1757 N KIMBALL AVE STE 205A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606474805",
            "telephone_number": "816-914-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIVODA",
        "first_name": "SARA",
        "middle_name": "PROBASCO",
        "credential": "MOT, OTR/L, CLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-30",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XF0002X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Feeding, Eating & Swallowing",
            "state": "IL",
            "license": "056.009836",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.009836",
            "primary": true
        },
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLEMENTINEPEDIATRICS",
            "identifier": "93-3026418",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "PROBASCO",
            "middle_name": "KAITLYN",
            "credential": "MOT, OTR/L, CLC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gesenia Viviescas
• Edward Geronimo Vivit, DDS
• Mary Kho Vivit, DDS
• Virginia Vivit, DC
• Michael Joseph Vivo, LPC
• Amainavt Vixama
• Diana Lou Vizcayno, FNP
• Paul Vizgirda, DDS
• Edmund Walter Vizinas, M.D.
• John Vizuete

• Occupational Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.