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NPI Code Detail

MEDICARE: MRS. SUSAN C KUPCZYK OTR/L

MEDICARE: MRS. SUSAN C KUPCZYK 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
1225X00000XOccupational Therapist056002556IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
102232364OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1962590729
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN C KUPCZYK OTR/L
Provider Business Mailing Address
First Line : 1409 W CARROLL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1105
Country : US
Telephone Number : 312-733-0883
Fax Number :
Provider Business Practice Location Address
First Line : 1409 W CARROLL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1105
Country : US
Telephone Number : 312-733-0883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 03/15/2023

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