Provider Demographics
NPI:1598001943
Name:MUNOZ, SUSAN JUNE (COTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JUNE
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E BOLIVAR AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILW
Mailing Address - State:WI
Mailing Address - Zip Code:53207
Mailing Address - Country:US
Mailing Address - Phone:414-416-9361
Mailing Address - Fax:
Practice Address - Street 1:8400 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-6327
Practice Address - Country:US
Practice Address - Phone:262-658-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant