Provider Demographics
NPI:1427215888
Name:BRUECKNER, SUELLEN (OTR,BCIAC-PMDB)
Entity Type:Individual
Prefix:
First Name:SUELLEN
Middle Name:
Last Name:BRUECKNER
Suffix:
Gender:F
Credentials:OTR,BCIAC-PMDB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4216
Mailing Address - Country:US
Mailing Address - Phone:414-259-7258
Mailing Address - Fax:414-259-7515
Practice Address - Street 1:201 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4216
Practice Address - Country:US
Practice Address - Phone:414-259-7258
Practice Address - Fax:414-259-7515
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI145-026225X00000X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation