Provider Demographics
NPI:1093037251
Name:SUJAK, KARLA M (OTR)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:M
Last Name:SUJAK
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 1:2406 HARTLAND RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-9763
Mailing Address - Country:US
Mailing Address - Phone:815-338-0312
Mailing Address - Fax:
Practice Address - Street 1:2406 HARTLAND RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-9763
Practice Address - Country:US
Practice Address - Phone:815-338-0312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2012-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4805-026225X00000X
IL056008783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist