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NPI Code Detail

MEDICARE: MRS. SUSAN MARIE BRUK OTR

MEDICARE: MRS. SUSAN MARIE BRUK OTR
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 Therapist72026WI

General Provider Information

NPI Number : 1619053584
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN MARIE BRUK OTR
Provider Business Mailing Address
First Line : 2115 S PARKSIDE DR
Second Line :
City : NEW BERLIN
State : WI
Zip : 53151-2383
Country : US
Telephone Number : 262-786-6788
Fax Number :
Provider Business Practice Location Address
First Line : 833 N 26TH ST
Second Line : PENFIELD CHILDREN'S CENTER
City : MILWAUKEE
State : WI
Zip : 53233-1507
Country : US
Telephone Number : 414-344-7676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 10/25/2016

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Directions to “ MRS. SUSAN MARIE BRUK OTR” Practice Location

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