Healthcare Provider Details

I. General information

NPI: 1841194586
Provider Name (Legal Business Name): SUSAN PETERS MS/OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 SEMINOLE ST
GRAFTON WI
53024-9353
US

IV. Provider business mailing address

2108 SEMINOLE ST
GRAFTON WI
53024-9353
US

V. Phone/Fax

Practice location:
  • Phone: 530-410-2331
  • Fax:
Mailing address:
  • Phone: 530-410-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5101-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: