Individual
SUSAN MARIE LICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
6100 MILLER AVE, GARY, IN 46403-2469
(219) 427-0196
Mailing address
13807 W 165TH AVE, LOWELL, IN 46356-9337
(219) 951-6161
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31004027A
IN
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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