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NPI Code Detail

MEDICARE: MRS. SUSAN L FLECK O.T.

MEDICARE: MRS. SUSAN L FLECK O.T.
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
1225X00000XOccupational Therapist1274-026WI

General Provider Information

NPI Number : 1588874812
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN L FLECK O.T.
Provider Business Mailing Address
First Line : W68N275 EVERGREEN BLVD
Second Line :
City : CEDARBURG
State : WI
Zip : 53012-2635
Country : US
Telephone Number : 414-839-9960
Fax Number : 262-789-5081
Provider Business Practice Location Address
First Line : 18740 W BLUEMOUND RD
Second Line :
City : BROOKFIELD
State : WI
Zip : 53045-2936
Country : US
Telephone Number : 262-782-0230
Fax Number : 262-789-5081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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