Healthcare Provider Details

I. General information

NPI: 1467685735
Provider Name (Legal Business Name): SUSAN M VIENS MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 GREATSTONE PT
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

2459 MILLERSBURG RUDDLES MILL RD
PARIS KY
40361-9369
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-4081
  • Fax: 859-224-4082
Mailing address:
  • Phone: 859-588-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberT4281
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR4403
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: