Healthcare Provider Details

I. General information

NPI: 1346031770
Provider Name (Legal Business Name): SUSAN DENISE CAUDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5386 WAYNE MADISON RD
TRENTON OH
45067-9444
US

IV. Provider business mailing address

4166 SOMERVILLE RD
SOMERVILLE OH
45064-9707
US

V. Phone/Fax

Practice location:
  • Phone: 513-288-4596
  • Fax:
Mailing address:
  • Phone: 513-523-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number09219
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: