Healthcare Provider Details

I. General information

NPI: 1063639953
Provider Name (Legal Business Name): SUSAN DIANE STERN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 GOLDEN FERN CT
ELKRIDGE MD
21075-5946
US

IV. Provider business mailing address

3103 SAINT FLORENCE TER
OLNEY MD
20832-1619
US

V. Phone/Fax

Practice location:
  • Phone: 410-796-8499
  • Fax: 443-270-8260
Mailing address:
  • Phone: 301-570-0348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number03889
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: