Provider Demographics
NPI:1194992123
Name:KINNEY, SUZANNE (OTR)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:KINNEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-5018
Mailing Address - Country:US
Mailing Address - Phone:608-957-2045
Mailing Address - Fax:
Practice Address - Street 1:4309 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-5018
Practice Address - Country:US
Practice Address - Phone:608-957-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4501-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist