Provider Demographics
NPI:1497146724
Name:CHARNLEY, SUSAN DEANNE (MS, OTR/L, CHT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DEANNE
Last Name:CHARNLEY
Suffix:
Gender:F
Credentials:MS, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 LISSON GRV
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9561
Mailing Address - Country:US
Mailing Address - Phone:815-260-6294
Mailing Address - Fax:
Practice Address - Street 1:16618 W 159TH ST
Practice Address - Street 2:STE 400
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8010
Practice Address - Country:US
Practice Address - Phone:815-834-8890
Practice Address - Fax:815-306-2889
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.005409225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand