Provider Demographics
NPI:1376610600
Name:FENDLER, SUSAN K (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:FENDLER
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 1:6822 CUMMINS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8069
Mailing Address - Country:US
Mailing Address - Phone:815-579-9543
Mailing Address - Fax:
Practice Address - Street 1:6822 CUMMINS DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8069
Practice Address - Country:US
Practice Address - Phone:815-579-9543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56006379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist