MEDICARE: SUSAN ROTMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist		IL

General Provider Information

NPI Number	:	1598960866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ROTMAN

Provider Business Mailing Address
First Line	:	111 HOGARTH LN
Second Line	:
City	:	GLENCOE
State	:	IL
Zip	:	60022-1325
Country	:	US
Telephone Number	:	847-835-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 HOGARTH LN
Second Line	:
City	:	GLENCOE
State	:	IL
Zip	:	60022-1325
Country	:	US
Telephone Number	:	847-835-0660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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Directions to “ SUSAN ROTMAN ” Practice Location

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