Healthcare Provider Details

I. General information

NPI: 1568533685
Provider Name (Legal Business Name): SUSAN G. HILL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 N. DRAKE AVE
CHICAGO IL
60625-5530
US

IV. Provider business mailing address

5005 N. DRAKE AVE
CHICAGO IL
60625-5530
US

V. Phone/Fax

Practice location:
  • Phone: 773-419-3337
  • Fax: 773-463-7802
Mailing address:
  • Phone: 773-419-3337
  • Fax: 773-463-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.001012
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: