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NPI Code Detail

MEDICARE: MS. SUSAN KATHERINE HERMIDA-VAN HORN O.T.R.

MEDICARE: MS. SUSAN KATHERINE HERMIDA-VAN HORN O.T.R.
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 TherapistIL

General Provider Information

NPI Number : 1831219492
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN KATHERINE HERMIDA-VAN HORN O.T.R.
Provider Business Mailing Address
First Line : 1020 N MOZART ST
Second Line : #1
City : CHICAGO
State : IL
Zip : 60622-1575
Country : US
Telephone Number : 312-493-1493
Fax Number : 773-256-5060
Provider Business Practice Location Address
First Line : 5548 S HYDE PARK BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60637-1909
Country : US
Telephone Number : 773-256-5050
Fax Number : 773-256-5060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 07/08/2007

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