Provider Demographics
NPI:1962638734
Name:BOSMAN, SUSAN LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:BOSMAN
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:W4912 FARM VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-2710
Mailing Address - Country:US
Mailing Address - Phone:262-742-4184
Mailing Address - Fax:
Practice Address - Street 1:211 S CURTIS ST
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-2052
Practice Address - Country:US
Practice Address - Phone:262-248-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2674-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist