Provider Demographics
NPI:1912121138
Name:QUINN, SUSAN JEAN (OTR)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:QUINN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JEAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:8439 167TH ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2216
Mailing Address - Country:US
Mailing Address - Phone:708-532-4604
Mailing Address - Fax:708-532-4604
Practice Address - Street 1:17800 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2029
Practice Address - Country:US
Practice Address - Phone:708-213-3829
Practice Address - Fax:708-213-0132
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056000310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist