Provider Demographics
NPI:1588874812
Name:FLECK, SUSAN L (OT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:FLECK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:W68N275 EVERGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2635
Mailing Address - Country:US
Mailing Address - Phone:414-839-9960
Mailing Address - Fax:262-789-5081
Practice Address - Street 1:18740 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2936
Practice Address - Country:US
Practice Address - Phone:262-782-0230
Practice Address - Fax:262-789-5081
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1274-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist