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General NPI Number Information
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NPI Number | 1831219492
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Entity Type | Individual
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Provider Name | SUSAN KATHERINE HERMIDA-VAN HORN O.T.R.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5548 S HYDE PARK BLVD
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City | CHICAGO
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State | IL
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Zip | 60637-1909
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Country | US
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Telephone | 773-256-5050
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Fax | 773-256-5060
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Provider Business Mailing Address
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Address Line | 1020 N MOZART ST #1
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City | CHICAGO
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State | IL
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Zip | 60622-1575
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Country | US
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Telephone | 312-493-1493
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Fax | 773-256-5060
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | IL
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