Healthcare Provider Details

I. General information

NPI: 1326389503
Provider Name (Legal Business Name): SUSAN DALE DOYLE B.O.T., M.SC. PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 MAIN ST STE 304
VANCOUVER WA
98663-2251
US

IV. Provider business mailing address

3305 MAIN ST STE 304
VANCOUVER WA
98663-2251
US

V. Phone/Fax

Practice location:
  • Phone: 360-723-5145
  • Fax: 360-282-6863
Mailing address:
  • Phone: 360-723-5145
  • Fax: 360-282-6863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License NumberOT00001975
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number986704
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number00001975
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: