Healthcare Provider Details

I. General information

NPI: 1437367984
Provider Name (Legal Business Name): SUZANNE SHRIVER PRATT MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE DEBRA SHRIVER MS OTR/L

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4166 RITTENHOUSE LN. BOX 7
SKIPPACK PA
19474
US

IV. Provider business mailing address

100 REEDEL RD. BOX 7
KING OF PRUSSIA PA
19406
US

V. Phone/Fax

Practice location:
  • Phone: 267-240-4361
  • Fax:
Mailing address:
  • Phone: 267-240-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC008481
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: