Healthcare Provider Details

I. General information

NPI: 1568554228
Provider Name (Legal Business Name): SUZANNE C. OBAN OTR/L.CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 HANCOCK BRIDGE PKWY STE 103
CAPE CORAL FL
33990-1455
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 239-574-7557
  • Fax: 239-574-1315
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056001363
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: