MEDICARE: SUSAN MCKAY OTR/L

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	056004460	IL

General Provider Information

NPI Number	:	1043765498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MCKAY OTR/L

Provider Business Mailing Address
First Line	:	39W531 S HYDE PARK
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-4926
Country	:	US
Telephone Number	:	815-748-8900
Fax Number	:	815-758-0717

Provider Business Practice Location Address
First Line	:	39W531 S HYDE PARK
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-4926
Country	:	US
Telephone Number	:	815-748-8900
Fax Number	:	815-758-0717

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

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	08/15/2016

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