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General NPI Number Information
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NPI Number | 1073378212
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Entity Type | Individual
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Provider Name | MRS. SUSAN FITZGERALD
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Gender | Female
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 1101 OHIO DR STE 105
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City | PLANO
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State | TX
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Zip | 75093-5331
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Country | US
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Telephone | 972-599-9594
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Fax |
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Provider Business Mailing Address
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Address Line | 600 JOSHUA RD
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City | LANTANA
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State | TX
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Zip | 76226-4361
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Country | US
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Telephone | 214-505-8685
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 106197
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License Number State | TX
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