Healthcare Provider Details

I. General information

NPI: 1356494074
Provider Name (Legal Business Name): SUSAN MARIE HURLEY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56299 29 PALMS HWY
YUCCA VALLEY CA
92284-2857
US

IV. Provider business mailing address

32790 NAVAJO TRL
CATHEDRAL CITY CA
92234-4075
US

V. Phone/Fax

Practice location:
  • Phone: 760-369-1743
  • Fax: 760-365-6934
Mailing address:
  • Phone: 760-369-1743
  • Fax: 760-365-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 5196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: