Provider Demographics
NPI:1245418755
Name:NEILL, SUSAN A (OT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:NEILL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12021 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1139
Mailing Address - Country:US
Mailing Address - Phone:708-923-1768
Mailing Address - Fax:708-923-1773
Practice Address - Street 1:12021 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1139
Practice Address - Country:US
Practice Address - Phone:708-923-1768
Practice Address - Fax:708-923-1773
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist