Healthcare Provider Details

I. General information

NPI: 1891734976
Provider Name (Legal Business Name): SUSAN PARIS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MEDICAL PARK DR TWO MEDICAL PK
MOBILE AL
36693-3330
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-665-8200
  • Fax: 251-665-8210
Mailing address:
  • Phone: 251-470-5842
  • Fax: 251-470-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0163
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: