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NPI Code Detail

MEDICARE: SUSAN PATRICIA CARMONA

MEDICARE: SUSAN PATRICIA CARMONA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist004531-1NY
2225X00000XOccupational TherapistOT6693OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
211225448OTHERNYCAQH
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609807361
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN PATRICIA CARMONA
Provider Business Mailing Address
First Line : 4710 OLD TROY PIKE
Second Line :
City : DAYTON
State : OH
Zip : 45424-5740
Country : US
Telephone Number : 937-855-7821
Fax Number : 937-855-6972
Provider Business Practice Location Address
First Line : 4710 OLD TROY PIKE
Second Line :
City : DAYTON
State : OH
Zip : 45424-5740
Country : US
Telephone Number : 937-855-7821
Fax Number : 937-855-6972
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 06/27/2008

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Directions to “ SUSAN PATRICIA CARMONA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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