Healthcare Provider Details

I. General information

NPI: 1174889257
Provider Name (Legal Business Name): SUSAN CATHERINE OCHELTREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 SPRING ST
PLACERVILLE CA
95667-4543
US

IV. Provider business mailing address

937 SPRING STREET
PLACERVILLE CA
95667
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-6219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: