Provider Demographics
NPI:1003020736
Name:KOENIG, SUSAN ROSE (OTR)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ROSE
Last Name:KOENIG
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 1:2517 BLUEWATER DR
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-5024
Mailing Address - Country:US
Mailing Address - Phone:847-487-0496
Mailing Address - Fax:
Practice Address - Street 1:1025 OLD MCHENRY RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-8428
Practice Address - Country:US
Practice Address - Phone:847-842-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist