MEDICARE: SUSAN MARIE HODGES OTR

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
1	225X00000X	Occupational Therapist	31000682A	IN

General Provider Information

NPI Number	:	1831301696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE HODGES OTR

Provider Business Mailing Address
First Line	:	4350 E RAY RD STE 101A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4707
Country	:	US
Telephone Number	:	480-704-5954
Fax Number	:	317-823-6327

Provider Business Practice Location Address
First Line	:	1332 E HIDDENVIEW DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-8674
Country	:	US
Telephone Number	:	317-670-9892
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	03/17/2022

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