Provider Demographics
NPI:1821020660
Name:HERTZLER, SUZANNE S (OTR)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:S
Last Name:HERTZLER
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 1:524 E MCKINLEY AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545
Mailing Address - Country:US
Mailing Address - Phone:574-255-8730
Mailing Address - Fax:574-255-8732
Practice Address - Street 1:524 E MCKINLEY AVE
Practice Address - Street 2:STE 1
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-255-8730
Practice Address - Fax:574-255-8732
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000640A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist