Provider Demographics
NPI:1013900455
Name:BOTICA, SUSAN L (OTR/L,CHT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:BOTICA
Suffix:
Gender:F
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:SCHRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L,CHT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:2534 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9712
Practice Address - Country:US
Practice Address - Phone:630-296-2223
Practice Address - Fax:630-759-3251
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056002054225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL670002092OtherRAILROAD PROVIDER #
IL670002092OtherRAILROAD PROVIDER #