Healthcare Provider Details

I. General information

NPI: 1326551615
Provider Name (Legal Business Name): SUE ANN ORDINETZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DRIVE SPINE CENTER
LEBANON NH
03756-1000
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE SPINE CENTER
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-2100
  • Fax: 603-653-2110
Mailing address:
  • Phone: 603-653-2100
  • Fax: 603-653-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number072.0081596
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number2496
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: