Provider Demographics
NPI:1588922595
Name:HOLT, SUSAN ANNE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANNE
Last Name:HOLT
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 HASSELL CIR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-6951
Mailing Address - Country:US
Mailing Address - Phone:847-884-9893
Mailing Address - Fax:
Practice Address - Street 1:1235 HASSELL CIR
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-6951
Practice Address - Country:US
Practice Address - Phone:847-884-9893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008532225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics