Individual
JILL SHEA SUESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
402 FIRST STREET, RANDOM LAKE, WI 53075
(920) 994-9700
(920) 994-4606
Mailing address
15985 W HEATHERLY DR, NEW BERLIN, WI 53151-5619
(262) 641-0805
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3789026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40902000
—
WI
Enumeration date
05/15/2007
Last updated
11/25/2009
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