Provider Demographics
NPI:1306086657
Name:BAUMGARTH-WILLIAMS, SUSAN J (COTA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:BAUMGARTH-WILLIAMS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 TEMPLE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61112-1097
Mailing Address - Country:US
Mailing Address - Phone:815-332-3272
Mailing Address - Fax:815-332-6752
Practice Address - Street 1:1545 TEMPLE LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61112-1097
Practice Address - Country:US
Practice Address - Phone:815-332-3272
Practice Address - Fax:815-332-6752
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057-000441224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant