Healthcare Provider Details

I. General information

NPI: 1427105956
Provider Name (Legal Business Name): SUSAN J OHANLON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 COQUINA RIDGE WAY
ORMOND BEACH FL
32174-1815
US

IV. Provider business mailing address

24 COQUINA RIDGE WAY
ORMOND BEACH FL
32174-1815
US

V. Phone/Fax

Practice location:
  • Phone: 904-309-0897
  • Fax:
Mailing address:
  • Phone: 904-309-0897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT10747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: