Healthcare Provider Details

I. General information

NPI: 1477725265
Provider Name (Legal Business Name): SUE HOSSACK MOT, OTR/L, ATP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 GORDON DR
BLACKSBURG VA
24060-8678
US

IV. Provider business mailing address

3261 GORDON DR
BLACKSBURG VA
24060-8678
US

V. Phone/Fax

Practice location:
  • Phone: 540-320-8454
  • Fax: 540-301-6372
Mailing address:
  • Phone: 540-320-8454
  • Fax: 540-301-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License NumberRESNA
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119003829
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: